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Clinical management of lumbar infectious spondylodiscitis is challenging due to its variable presentation and complex course, and its treatment remains controversial. This study aims to evaluate the clinical efficacy of unilateral biportal endoscopic (UBE) debridement and drainage for treating lumbar infectious spondylodiscitis. We retrospectively analysed sixteen patients diagnosed with lumbar infectious spondylodiscitis who underwent UBE debridement and drainage between April 2022 and July 2023. Biopsy specimens were sent to the laboratory to identify pathogens immediately after surgeries. Clinical outcomes were assessed by the visual analog scale (VAS) scores of the back, Oswestry Disability Index (ODI), the modified MacNab criteria (MNC), and regular serological tests at pre- and post-operation. Fourteen patients (87.5%) experienced a significant improvement in their clinical symptoms. Their VAS and ODI scores significantly improved compared to those before the operation throughout the follow-up (p<0.05). The modified MNC at the last follow-up indicated that 87.50% of these participants were rated excellent or good. Causative bacteria were identified in 13 (81.25%) of 16 biopsy specimens. At the final follow-up, all patients' kyphotic angle changes were less than 10° without spinal instability. A 12-month follow-up CT scan revealed bony intervertebral fusion in 10 cases (62.5%). The postoperative regular serological tests were significantly improved than before surgery (p< 0.05). No recurrent infections or significant surgery-related complications were observed during postoperative follow-up. UBE surgery was successful in debridement, back pain relief, and bacteriologic diagnosis of lumbar infectious spondylodiscitis. This procedure could be an effective alternative for patients when conservative treatments fail.

Objective This study systematically assesses the learning curve of Unilateral Biportal Endoscopic (UBE) techniques across various spinal surgeries, focusing on its influence on operative efficiency and complication rates to guide optimized training and practice. Methods Systematic searches in PubMed, Web of Science, Embase, Scopus, and Cochrane Library identified studies on UBE learning curves for patients aged 18 or older, comparing early and mastery phases. Two reviewers independently extracted data on surgery type, operative time, and complications. Study quality was assessed using the Newcastle–Ottawa Scale. We performed subgroup analyses based on different UBE surgery types, examining variations in operative time and complication rates across each procedure. Results Thirteen studies, including 1217 patients, were included, focusing on lumbar spine surgeries. The average learning curve cutoff for UBE procedures was 32.18 cases, with the mastery phase reducing operative time by an average of 48.14 min (95% CI 35.80, 60.47; p  < 0.001), although high heterogeneity observed. In the mastery phase, single-group analysis of 707 patients showed a mean operative time of 92.38 min (95% CI 77.35, 107.41). Complication analysis across 12 studies (1182 patients) revealed a significantly lower rate in the mastery phase (odds ratio, OR = 0.29; p  < 0.001). Subgroup analyses revealed significant reductions in both operative time and complications for UBE-LIF and UBE-LD/ULBD during the mastery phase, while no significant changes were observed for UBE-PCF. Additionally, specific complications, such as dural tears and incomplete decompression, were significantly reduced in the mastery phase. Conclusion This systematic review confirms a learning curve in UBE surgery, with improvements in operative time and complications. Procedure-specific cutoff points provide guidance for training and future research.

Objective The purpose of this study was to investigate the learning curve of percutaneous endoscopic transforaminal discectomy (PETD) and interlaminar unilateral biportal endoscopic discectomy (UBED) in the treatment of lumbar disc herniation (LDH). Methods Between 2018 and 2023, 120 consecutive patients with lumbar disc herniation (LDH) treated by endoscopic lumbar discectomy were retrospectively included. The PETD group comprised 87 cases, and the UBED group comprised 33 cases. Cumulative sum analysis was used to evaluate the learning curve, with the occurrence of complications or unresolved symptoms defined as surgical failure, and variables of different phases of the learning curve being compared. Results The learning curve analysis identified the cutoff point at 40 cases in the PETD group and 15 cases in the UBED group. In the mastery phase, both PETD and UBED demonstrated a significant reduction in operation times (approximately 38 min for PTED and 49 min for UBED). In both PETD and UBED groups, the surgical failure rates during the learning and mastery phases showed no statistically significant differences. The visual analogue scale at the last follow-up was significantly lower than before surgery in both the PETD and UBED groups. Conclusion PETD and UBED surgery are effective in the treatment of LDH with a low incidence of complications. However, achieving mastery in PETD necessitates a learning curve of 40 cases, while UBED requires a minimum of 15 cases to reach proficiency.

PurposeArticles evaluating radiofrequency (RF) safety are insufficient. Thus, the purpose of this study was to investigate RF safety during biportal endoscopic lumbar decompressive laminotomy by measuring epidural temperature after RF use.MethodsBoth in vitro cadaveric study and in vivo study were performed. The epidural temperature was measured at epidural space after RF use in three cadavers. The epidural temperature was measured and analysed according to RF mode, RF power, RF usage time, and saline irrigation patency. In the in vivo study, the epidural temperature was measured after biportal endoscopic surgery. Epidural temperatures were measured around ipsilateral and contralateral traversing nerve roots after 1-s use of RF.ResultsIn the in vivo study, epidural space temperature was increased by 0.31 ± 0.16 °C ipsilaterally and 0.29 ± 0.09° contralaterally after RF use in coagulation mode 1. The epidural temperature of epidural space was increased by 0.21 ± 0.13 °C ipsilaterally and 0.15 ± 0.21 °C contralaterally after RF use in high mode 2. In the in vitro study, epidural temperature was significantly increased with a long duration of RF use and a poor patency of irrigation fluid.ConclusionThe use of RF in biportal endoscopic spine surgery might be safe. In order to reduce indirect thermal injuries caused by RF use, it might be necessary to reduce RF use time and maintain continuous saline irrigation patency well.

BackgroundEndoscopic spine surgery has been established as a practical, minimally invasive technique for decompression in patients with lumbar spinal stenosis. However, there remains a paucity of studies prospective cohort study comparing uniportal lumbar endoscopic unilateral laminotomy with bilateral decompression and unilateral biportal endoscopic unilateral laminotomy with bilateral decompression with open spinal decompression—both viable techniques with satisfactory clinical outcomes in the treatment of lumbar spinal stenosis.Objective/aimTo compare the efficacy of UPE and BPE lumbar decompression surgery for patients with lumbar spinal stenosis.MethodsA prospective registry of patients who had undergone spinal decompression for lumbar stenosis via UPE or BPE under a single fellowship trained spine surgeon was studied. Baseline characteristics, initial clinical presentation, and operative details including complications were recorded for all included patients. Clinical outcomes, such as visual analogue scale and Oswestry Disability Index, were recorded at preoperative, immediate postoperative, 2-week, 3-, 6-, and 12-month follow-up periods.ResultsA total of 62 patients underwent endoscopic decompression surgery for lumbar spinal stenosis (29 UPE, 33 BPE). No significant baseline differences were found between uniportal and biportal decompression, when comparing operative duration (130 vs. 140 min; p = 0.30), intraoperative blood loss (5.4 vs. 6mLs; p = 0.05), and length of hospital stay (23.6 vs. 20.3 h; p = 0.35). Two patients (7%) who underwent uniportal endoscopic decompression required conversion to open surgery due to inadequate decompression. Intraoperative complication rates were significantly higher in the UPE group (13.4% vs. 0%, p < 0.05). VAS score (leg & back) and ODI improved significantly (p < 0.001) in both endoscopic decompression groups across all follow-up time points, with no appreciable statistical differences between both groups. ConclusionUPE has the same efficacy as BPE in the treatment of lumbar spinal stenosis. While UPE surgery enjoys added aesthetic benefits of only one wound, BPE had potentially lower risks of intraoperative complication, inadequate decompression, and conversion to open surgery during early period of learning curve.

Background Conventional unilateral biportal endoscopic discectomy for subarticular herniations frequently necessitates extensive hemilaminectomy, increasing the risks of iatrogenic instability and epidural scarring. Method The K-point approach is a precision docking technique utilizing the medial junction between the inferior and superior articular processes. By creating a strategic lateral corridor, it minimizes bone removal and exposes the lateral margin of the ligamentum flavum, allowing direct access to the traversing nerve root. Conclusion By reducing bone resection and preserving the ligamentum flavum, the K-point approach enhances surgical efficiency and provides a refined minimally invasive alternative for subarticular disc herniations.

Background Currently, hidden blood loss (HBL) has been paid more and more attention by spine surgeons. Simultaneously, it has been the effort of spine surgeons to explore more advantages of minimally invasive surgery. More and more articles have compared unilateral biportal endoscopic lumbar interbody fusion (BE-LIF) and minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF). But so far, there is no HBL comparison between BE-LIF and MIS-TLIF. This study aims to compare the surgical invasiveness, hidden blood loss, and clinical outcome of BE-LIF and MIS-TLIF and to provide insight regarding minimally invasive surgery for lumbar degenerative disease (LDD). Methods We enrolled 103 eligible patients with LDD who underwent BE-LIF (n = 46) and MIS-TLIF (n = 57) during August 2020–March 2021. We collected data, including demographics, perioperative haematocrit, operative and postoperative hospital times, serum creatine kinase (CK) and C-reactive protein (CRP) levels, and hospitalization costs. Total and hidden blood loss was calculated. Clinical outcomes were assessed using a visual analogue scale (VAS) score for back and leg pain, Oswestry Disability Index (ODI), modified MacNab criteria, fusion rate, and complications. Results Basic demographics and surgical data were comparable. The CRP and CK levels were generally lower in the BE-LIF than in the MIS-TLIF group, especially CRP levels on postoperative day (POD) three and CK levels on POD one. True total blood loss, postoperative blood loss, and hidden blood loss were significantly reduced in the BE-LIF group compared with the MIS-TLIF group. Postoperative hospital times was statistically significantly shorter in the BE-LIF group. The VAS pain and ODI scores improved in both groups. At three days and one month, the VAS lower back pain scores were significantly better after BE-LIF. Clinical outcomes did not otherwise differ between groups. Conclusions Compared with MIS-TLIF, BE-LIF has similar medium and short-term clinical outcomes. However, it is better regarding surgical trauma, early lower back pain, total and hidden blood loss, and recovery time. BE-LIF is an adequate option for selected LDD.

Objective This study aimed to compare the efficacy and cost-utility of unilateral biportal endoscopy (UBE) versus percutaneous endoscopic interlaminar discectomy (PEID) for the treatment of single-level lumbar disc herniation (LDH). Methods A retrospective analysis was conducted on 99 patients who underwent either UBE ( n  = 33) or PEID ( n  = 66) between July 2022 and December 2023 at the Second Xiangya Hospital. Patients were matched 1:2 based on age, sex, and surgery level to ensure comparability. Clinical outcomes were assessed using Visual Analog Scale (VAS), European Quality of Life-5 Dimensions (EQ-5D), and Oswestry Disability Index (ODI) scores, with quality-adjusted life years (QALYs) calculated for cost-utility analysis. Hospitalization costs were analyzed, and the incremental cost-utility ratio (ICER) was determined. Results Both UBE and PEID groups demonstrated significant postoperative improvements in VAS, EQ-5D, and ODI scores ( p  < 0.05). The operative time, blood loss and nursing cost were significantly higher for UBE compared to PEID ( p  < 0.05). UBE has higher gained QALY and overall costs, but the differences are not statistically significant ( p  = 0.643 for QALY, p  = 0.327 for costs). The Incremental Cost-Effectiveness Ratio (ICER) for UBE compared to PEID was calculated to be $354.5 per QALY gained, indicating that for each additional QALY gained through UBE, an additional cost of $354.5 is incurred compared to PEID. Conclusion In our single-center study conducted in China, both the UBE and PEID procedures have demonstrated comparable short-term efficacy in alleviating pain and improving functional ability in patients with single-level LDH. UBE procedure demonstrates greater cost-utility than the PEID procedure in cost-utility analysis, despite its longer operative time, higher nursing costs and greater blood loss.

This study aimed to evaluate the impact of unilateral biportal endoscopy (UBE) assisted interbody fusion on the functional recovery of patients diagnosed with lumbar disc herniation (LDH). From October 2021 to October 2022, 132 patients with LDH were selected as the research objects. The clinical data were retrospectively analyzed. According to the different surgical methods, LDH patients were divided into experimental group and control group (n = 66). The control group underwent conventional posterior lumbar open interbody fusion surgery, while the experimental group received interbody fusion surgery assisted by UBE. The clinical efficacy and perioperative indicators (operation time, total blood loss, 48 h postoperative drainage volume, and length of hospital stay) were recorded and compared between the two groups. The lumbar spine imaging parameters (lumbar lordosis index, posterior disc height, intervertebral space height, and Cobb Angle) before and after treatment were compared between the two groups. Lumbar function was evaluated using the Japanese Orthopedic Association (JOA) score, the Visual Analogue Scale (VAS), and the Oswestry Disability Index (ODI). Quality of life was assessed using the World Health Organization Quality of Life Scale (WHO-QOL-BREF). The incidence of complications after treatment was compared between the two groups. Multivariate logistic regression analysis was employed to identify influencing factors. In terms of low back pain improvement, the effective rate of the experimental group was 96.97%, which was significantly higher than 80.30% of the control group (P < 0.01). In terms of leg pain improvement, the effective rate of the experimental group was 95.45%, which was significantly higher than 75.76% of the control group (P < 0.01). The operation time and length of hospital stay in the experimental group were shorter than those in the control group (P < 0.001). The total blood loss and 48 h postoperative drainage volume in the experimental group were significantly less than those in the control group (P < 0.001). The lumbar lordosis index and posterior disc height of the two groups after operation were significantly higher than those before operation (P < 0.05). The intervertebral space height and Cobb Angle of the two groups after operation were significantly lower than those before operation (P < 0.05). The improvement of lumbar imaging parameters in the experimental group after operation was significantly better than that in the control group (P < 0.01). The JOA scores of the two groups after operation were significantly higher than those before operation, and the VAS scores of low back pain and leg pain and ODI scores were significantly lower than those before operation (P < 0.05). The improvement of the above indexes in the experimental group after operation was significantly better than that in the control group (P < 0.01). The incidence of complications in the experimental group was significantly lower than that in the control group (P < 0.01). The WHOQOL-BREF scores of the two groups after surgery were significantly higher than those before surgery (P < 0.05). The improvement of WHOQOL-BREF score in the experimental group after surgery was significantly better than that in the control group (P < 0.001). Multivariate Logistic regression analysis showed that UBE-assisted interbody fusion was an independent protective factor for good clinical efficacy in patients with LDH after adjusting the covariates of clinical symptom distribution, trauma history and Modic changes (P < 0.05). UBE interbody fusion has certain clinical advantages in the treatment of LDH. Compared with conventional open surgery, UBE interbody fusion has less bleeding and faster postoperative recovery. Moreover, UBE interbody fusion can relieve the symptoms of low back pain, promote the recovery of lumbar function and improve the quality of life. UBE interbody fusion is a safe and feasible choice in clinical treatment.

Objective: The purpose of this study was to compare the clinical and radiological outcomes of unilateral biportal endoscopic (UBE) and percutaneous posterior endoscopic cervical discectomy (PE) keyhole surgeries. Methods: Patients diagnosed with cervical spondylotic radiculopathy (CSR) treated by UBE or PE keyhole surgery from May 2017 to April 2020 were retrospectively analyzed. The length of incision, fluoroscopic time, postoperative hospital stay, and total cost were compared. The clinical efficacy was assessed using a visual analog scale (VAS), neck disability index (NDI), and modified MacNab criteria. Moreover, the C2-7 Cobb’s angle, range of motion (ROM), intervertebral height, vertebral horizontal displacement, and angular displacement of the surgical segment were measured. Results: A total of 154 patients were enrolled, including 89 patients in the UBE group and 65 patients in the PE group, with a follow-up period of 24–32 months. Compared with PE surgery, UBE surgery required shorter fluoroscopic times (6.76 ± 1.09 vs. 8.31 ± 1.10 s) and operation times (77.48 ± 17.37 vs. 84.92 ± 21.97 min) but led to higher total hospitalization costs and longer incisions. No significant differences were observed in the postoperative hospital stay, bleeding volume, VAS score, NDI score, effective rate, or complication rate between the UBE and PE groups. Both the C2-7 Cobb’s angle and ROM increased significantly after surgery, with no significant differences between groups. There were no significant differences between intervertebral height, vertebral horizontal displacement, and angular displacement of the surgical segment at different times. Conclusions: Both UBE and PE surgeries in the treatment of CSR were effective and similar after 24 months. The fluoroscopic and operation times of UBE were shorter than those of PE.