Learning Curve and Complications of Unilateral Biportal Endoscopy: Cumulative Sum and Risk-Adjusted Cumulative Sum Analysis

Jinchao Xu,Dong Wang,Jidan Liu,Chengyue Zhu,Jianhang Bao,Wenshuo Gao,Wei Zhang,Hao Pan 대한척추신경외과학회 2022 Neurospine Vol.19 No.3

Objective: The purpose of this study was to investigate the learning curve and complications of unilateral biportal endoscopy (UBE) in the treatment of lumbar disc herniation (LDH) and lumbar spinal stenosis (LSS). Methods: This was a retrospective cohort analysis of 197 consecutive patients who received UBE unilateral laminotomy bilateral decompression (UBE-ULBD) or lumbar discectomy (UBE-LD) surgery, including 107 males and 90 females with an average age of 64.83 ± 14.29 years. Cumulative sum (CUSUM) and risk-adjusted cumulative sum analysis (RA-CUSUM) were used to evaluate the learning curve, with the occurrence of complications defined as surgical failure, and variables of different phase of the learning curve were compared. Results: The cutoff point of learning curve of UBE surgery was 54 cases according to CUSUM analysis. The learning curve of UBE-ULBD and UBE-LD were divided into 3 phases. The first cutoff points were 31 and 12 cases, and the second cutoff point were 67 and 32 cases respectively. With the progress of the learning curve, the operation time and postoperative hospital stays decreased. The visual analogue scale and Oswestry Disability Index at the last follow-up were significantly lower than that before surgery. The incidence of surgical failure was 6.11% and began to decrease after the 89th case based on RA-CUSUM analysis. The surgical failure rate decreased from 10.11% to 2.78 after the 89th case with significant different. Conclusion: UBE surgery is effective in the treatment of LDH and LSS with low incidence of complications. But a learning curve of at least 54 cases still required for mastering UBE surgery.

The insert and revolve technique: a novel approach for inserting cages during unilateral biportal endoscopic assisted fusion surgery for effective spinal alignment restoration

Ha Ji Soo,Kulkarni Shreenidhi,Kim Do-Hyoung,Kim Chang-Wook,Sakhrekar Rajendra,Han Hee-Don 대한척추외과학회 2024 Asian Spine Journal Vol.18 No.4

Study Design: Retrospective study.Purpose: This study aimed to propose a method of performing unilateral biportal endoscopy (UBE)-assisted interbody cage insertion for fusion using the “insert and revolve” technique and analyze the clinico-radiological outcomes.Overview of Literature: UBE-assisted lumbar interbody fusion (ULIF) is a rapidly evolving technique combining the advantages of minimally invasive technique with ease of learning. The limited size of cages was a result of the narrow insertion channel. We propose a technique in which large extreme lateral interbody fusion cages can be inserted through the same opening.Methods: This study included 104 patients who underwent ULIF using the “insert and revolve technique” between July 2019 and September 2022. The patients were followed up for at least 12 months postoperatively. The clinical outcomes were assessed using the Visual Analog Scale (VAS) for leg pain and back pain, Oswestry Disability Index (ODI), and modified McNab’s criteria. Changes in segmental lordosis (SL), intervertebral disc height (IVDH), segmental coronal alignment (SCA), cage subsidence, and fusion grade were evaluated at 6- and 12-month follow-up.Results: The VAS scores for leg and back pain and ODI score showed significant improvement. Based on the Macnab’s criteria, 97 patients showed excellent outcomes and seven demonstrated good outcomes at 12 months. The mean IVDH increased from 6.3±2 to 10±2.1 mm immediately after surgery and 10±1.1 mm at 6 months. SL improved from 9.3°±11.5° to 17.78°±8.1°, while SCA improved from 7.7°±2.1° to 3.4°±1.2° at 1 year. Moreover, 92 and 11 patients showed grade 1 and 2 fusion, respectively, according to the Bridwell grading at 1 year.Conclusions: The “insert and revolve technique” facilitates the successful insertion of large cages, contributing to the restoration of disc height and coronal and sagittal spinal correction with favorable fusion rates.

Unilateral Biportal Endoscopy for Decompression of Extraforaminal Stenosis at the Lumbosacral Junction: Surgical Techniques and Clinical Outcomes

박만규,손상규,박원욱,최승현,정대영,김동한 대한척추신경외과학회 2021 Neurospine Vol.18 No.4

Objective: The aims of this study were to describe the unilateral biportal endoscopic (UBE) technique for decompression of extraforaminal stenosis at L5–S1 and evaluate 1-year clinical outcomes. Especially, we evaluated compression factors of extraforaminal stenosis at L5–S1 and described the surgical technique for decompression in detail. Methods: Thirty-five patients who underwent UBE decompression for extraforaminal stenosis at L5–S1 between March 2018 and February 2019 were enrolled. Clinical results were analyzed using the MacNab criteria, the visual analogue scale (VAS) for back and leg pain, and the Oswestry Disability Index (ODI). Compression factors evaluated pseudoarthrosis within the transverse process of L5 and ala of sacrum, disc bulging with or without osteophytes, and the thickened lumbosacral and extraforaminal ligament. Results: The mean back VAS was 3.7±1.8 before surgery, which dropped to 2.3±0.8 at 1-year postoperative follow-up (p<0.001). There was a significant drop in postoperative mean VAS for leg pain from 7.2±1.1 to 2.3±1.2 at 1 year (p<0.001). The ODI was 61.5 before surgery and 28.6 (p<0.001). Pseudoarthrosis between the transverse process and the ala was noted in all cases (35 of 35, 100%). Pure disc bulging was seen in 12 patients (34.3%), and disc bulging with osteophytes was demonstrated in 23 patients. The thickened lumbosacral and extraforaminal ligament were identified in 19 cases (51.4%). No complications occurred in any of the patients. Conclusion: In the current study, good surgical outcomes without complications were achieved after UBE decompression for extraforaminal stenosis at L5–S1.

Comparison of Unilateral Biportal Endoscopy Decompression and Microscopic Decompression Effectiveness in Lumbar Spinal Stenosis Treatment: A Systematic Review and Meta-analysis

Junjie Li,Jiheng Yin,Jun Liu,haixiong Lin,Haifeng Yuan 대한척추외과학회 2023 Asian Spine Journal Vol.17 No.2

This study aimed to compare the safety and effectiveness between unilateral biportal endoscopy (UBE) technique and microscopic decompression (MD) technique in lumbar spinal stenosis treatment. PubMed, Cochrane Library, Embase, Web of Science, China National Knowledge Infrastructure, and other databases were used to conduct extensive literature searches. RevMan ver. 5.3 software was used for the statistical analysis. Eleven studies were included with 930 patients, including 449 patients in the UBE group and 521 in the MD group. Both techniques revealed similar operative times at −1.77 minutes (95% confidence interval [CI], −7.59 to 4.05 minutes; p =0.55), the postoperative dural expansion area at −1.27 (95% CI, −19.30 to 16.77; p =0.89), the postoperative complications at 0.76 (95% CI, 0.47 to 1.22; p =0.26), the preoperative Visual Analog Scale (VAS) for leg pain, and the last follow-up (>12 months) VAS for leg pain at −0.04 (95% CI, −0.14 to 0.06; p =0.47), the preoperative Oswestry Disability Index (ODI), and the last follow-up (>12 months) ODI scores at −0.18 (95% CI, −0.76 to 0.40; p =0.54), and patient satisfaction (the modified MacNab score) at 1.15 (95% CI, 0.54 to 2.42; p =0.72). However, intraoperative bleeding was lower following the UBE technique at −52.78 mL (95% CI, −93.47 to −12.08 mL; p =0.01) and was shorter following the UBE technique at −3.06 (95% CI, −3.84 to −2.28; p <0.01). UBE and MD technology have no significant differences in efficacy or safety in the treatment of patients with lumbar spinal stenosis based on this meta-analysis. However, the UBE technique has less intraoperative bleeding and a shorter hospital stay. It has a slight advantage and is a better surgical option than the MD technique. It can be an alternative minimally invasive spinal surgery method.

편측 양방향 척추내시경을 이용한 골다공증 요추 압박 골절로 인해 발생한 급성 방사통의 치료 - 증례 보고 -

김형복,정훈재 대한척추외과학회 2019 대한척추외과학회지 Vol.26 No.1

Study Design: Case report. Objectives: To document unilateral biportal endoscopy (UBE) as a treatment for acute radiculopathy after osteoporotic vertebral fracture. Summary of Literature Review: Acute radiculopathy after osteoporotic vertebral fracture leads to claudication. Treatment of osteoporotic vertebral fractures with accompanying radiating pain is challenging. Materials and Methods: A 74-year-old woman was diagnosed with an osteoporotic vertebral fracture at L3 after slipping and falling. Vertebroplasty was performed for the osteoporotic vertebral fracture at L3. She still complained of right lower extremity radiating pain. UBE was performed to treat acute radiculopathy. Results: Foraminal decompression using UBE was performed at the L3-4 right foraminal area. Her symptoms resolved after surgery. Conclusions: UBE is a useful treatment method for acute radiculopathy after osteoporotic vertebral fracture. 연구 계획: 증례 보고목적: 골다공증성 척추 골절 이후 발생한 급성 방사통에 대한 치료로서 편측 양방향 척추내시경을 보고하고자 한다. 선행 연구문헌의 요약: 골다공증성 척추 골절 이후 발생한 급성 방사통은 파행의 원인이 될 수 있으며, 그에 대한 치료는 상당히 까다롭다고 알려져 있다. 대상 및 방법: 74세 여자 환자는 낙상 이후 시행한 검사상 요추 제 3번 골다공증성 척추 골절을 진단받았다. 골다공증성 척추 골절로 인한 증상이 지속되어 척추성형술을 시행한 이후 요통은 호전되었으나, 우측 하지의 방사통은 지속되었다. 이에 급성 방사통을 치료하기 위해 편측 양방향 척추내시경을 시행하였다. 결과: 우측 요추 제 3-4번 추간공 부위에 편측 양방향 척추내시경을 이용해 추간공 확장술을 시행하였으며, 이후 환자의 방사통은 호전되었다. 결론: 양방향 척추내시경은 골다공증성 척추 골절 이후 발생한 급성 방사통에 대한 유용한 치료법으로 생각된다. 약칭 제목: 골다공증성 척추 골절에서의 양방향 척추내시경

Remote Spinal Subdural Hematoma Following Lumbar Biportal Endoscopic Surgery : Two Case Reports

Sang Youp Han,Jae-Won Jang,Yong Eun Cho,Choon Keun Park 대한신경외과학회 2026 Journal of Korean neurosurgical society Vol.69 No.2

Remote spinal subdural hematoma (SSH) following unilateral biportal endoscopic (UBE) spine surgery is rare, even without intraoperative dural injury. We report two such cases. A 76-year-old woman underwent anterior lumbar interbody fusion and UBE decompression for lumbar spinal stenosis. Intraoperatively, dense adhesions were noted, but no cerebrospinal fluid (CSF) leakage occurred. Postoperatively, she developed left leg monoplegia. Magnetic resonance imaging (MRI) revealed a subdural hematoma at L2-3, remote from the surgical site. She recovered completely with steroid therapy and conservative management. An 88-year-old man underwent left-sided UBE laminotomy for central stenosis. The procedure was uneventful. Postoperative MRI revealed an incidental subdural hematoma from L2-4 without neurological deficits. He was observed conservatively. Both patients showed favorable outcomes without surgical evacuation. Remote SSH is a rare but important complication following UBE surgery. It should be considered when unexpected neurological deficits occur postoperatively, even in the absence of visible dural tears. Prompt diagnosis is essential for optimal management.

O-Arm Navigation-Guided Unilateral Biportal Endoscopic Decompression of Far-Out Syndrome

Rohit Akshay Kavishwar,Yi-Hao Liang,이동언,김재환,Maria Pedraza,김진성 대한척추신경외과학회 2024 Neurospine Vol.21 No.4

The main aim of this video article is to demonstrate the combined use of O-arm navigation and unilateral biportal endoscopy (UBE) to manage far-out syndrome (FOS). In FOS there is entrapment and compression of the fifth lumbar nerve beyond the foramen and between L5 transverse process and the sacral ala at the lumbosacral junction. Conventional microscopic decompression using a paraspinal approach had been the gold standard for its management. However, the surgery is technically challenging due to the deep location of the pathology and intricate anatomy of extraforaminal space. There have been some published reports of unsatisfactory outcomes with microscopic decompression for FOS. We decided to integrate navigation with UBE to increase precision for the management of FOS. A 70-yearold female presented to us with chief complaint of left lower limb radiculopathy since 1 year. She also complained of numbness and paresthesias in her left leg and foot. She was unable to walk for more than 10 minutes due to pain. Her magnetic resonance imaging scan revealed compression of left L5 nerve root in the extraforaminal region. UBE decompression via paraspinal approach was performed for her under O-arm navigation. She experienced immediate relief of her symptoms in the postoperative period. O-arm-navigation-guided UBE is an effective and safer alternative to microsurgical decompression for the management of FOS. This video demonstrates the step-by-step implementation of O-arm navigation with endoscopy and its precise execution.

Far-Lateral Transforaminal Unilateral Biportal Endoscopic Lumbar Discectomy for Upper Lumbar Disc Herniations

Jin Seop Hwang,Sang Hyub Lee,Dain Jeong,Jae-Won Jang,Yong Eun Cho,Dong-Geun Lee,Choon Keun Park,Chung Kee Chough 대한척추신경외과학회 2025 Neurospine Vol.22 No.1

Objective: The upper lumbar region has distinctive anatomical characteristics that contribute to the challenges of performing discectomy. We introduce far-lateral transforaminal unilateral biportal endoscopic (UBE) lumbar discectomy for central or paracentral disc herniations in the upper lumbar region. Methods: We conducted retrospective review of the patients who underwent a far-lateral transforaminal UBE lumbar discectomy at our institution from January 2018 to September 2024. The electronic medical records, operative records, and radiologic images of the patients were reviewed. Results: A total of 27 patients underwent far-lateral transforaminal UBE lumbar discectomy for central or paracentral disc herniations in the upper lumbar region. The patient had a mean age of 54.0 ± 13.7 years. Operation was performed at the L1–2 level in 3 patients (11.1%), L2–3 in 9 patients (33.3%), and L3–4 in 15 patients (55.6%). The patients were followed-up for a mean of 27.7 ± 19.3 months. The Oswestry Disability Index was significantly decreased from 36.3 ± 6.8 preoperatively to 3.7 ± 3.3 at last follow-up (p < 0.001). The vi sual analogue scale (VAS) back was significantly decreased from 7.8 ± 0.9 preoperatively to 3.1 ±0.6 postoperative day 2 (p < 0.001). The VAS leg was significantly decreased from 8.1 ±0.8 preoperatively to 2.3 ± 0.7 postoperative day 2 (p < 0.001). Conclusion: The far-lateral transforaminal UBE lumbar discectomy would be a viable surgical option for upper lumbar disc herniations.

Percutaneous Full-Endoscopic versus Biportal Endoscopic Posterior Cervical Foraminotomy for Unilateral Cervical Foraminal Disc Disease

Min-Seok Kang,Ki-Han You,Song-Yup Han,Sang-Min Park,Jun-Young Choi,Hyun-Jin Park 대한정형외과학회 2022 Clinics in Orthopedic Surgery Vol.14 No.4

Background: The biportal endoscopic technique (BE) is a fast-growing surgical modality that can be applied to posterior cervical foraminotomy (PCF), as well as lumbar discectomy and decompressive laminectomy. It has several technical differences from the percutaneous full-endoscopic technique (PE), which has been standardized as the representative endoscopic spinal surgery technique. The purpose of this study was to compare the short-term clinical outcomes between BE-PCF and PE-PCF. Methods: A retrospective review was conducted on 66 patients who had single-level unilateral cervical foraminal disc disease (UCFD). All patients underwent PE- or BE-PCF. Clinical outcomes including visual analog scale (VAS)-arm, VAS-neck, and Neck Disability Index (NDI) were evaluated. Perioperative data including operation time, length of hospital stay (LOS), amount of surgical drain, postoperative complications, and reoperation were collected. Serum creatine phosphokinase (CPK) and C-reactive protein (CRP) levels were recorded. Results: A total of 65 patients were included in the final analysis: 32 with PE-PCF and 33 with BE-PCF. There was no statistically significant difference in demographic and preoperative data between the two groups. All patients had significant improvement in VAS-arm, VAS-neck, and NDI compared to the baseline value. The improvement of all parameters was comparable between the two groups at each point for 1 year after surgery (p > 0.05), except for the significantly lower VAS-neck at postoperative 2 days in PE-PCF (p = 0.005). The total operation time was significantly shorter in BE-PCF (p = 0.036). There were no statistically significant differences between the two groups in regard to LOS, amount of surgical drain, and serum CPK and CRP levels (p > 0.05). Reoperation and complications between the two groups were comparable (p > 0.05). Conclusions: The 1-year postoperative clinical outcomes of PE-PCF and BE-PCF for cervical pain and disability caused by UCFD were good and comparable. PE-PCF resulted in significantly less immediate postoperative neck pain, but BE-PCF required shorter total operation time.

The Utilization of Navigation and Emerging Technologies With Endoscopic Spine Surgery: A Narrative Review

Abhinav K. Sharma,Rafael Garcia de Oliveira,Siravich Suvithayasiri,Piya Chavalparit,Chien Chun Chang,Yong H. Kim,Charla R. Fischer,Sang Lee,Samuel Cho,Jin-Sung Kim,Don Young Park 대한척추신경외과학회 2025 Neurospine Vol.22 No.1

Endoscopic spine surgery (ESS) is growing in popularity worldwide. An expanding body of literature demonstrates rapid functional recovery with reduced morbidity compared to open techniques. Both full endoscopic spine surgery, or uniportal endoscopy, and unilateral bi portal endoscopy (UBE) can be employed in conjunction with various navigation and en abling technologies for assistance with localization of anatomic orientation and assessment of the intraoperative target spinal pathology. This review article describes various naviga tion technologies in ESS, including 2-dimensional (2D) fluoroscopic imaging, 2D fluoro scopic navigation, 3-dimensional C-arm navigation, augmented reality, and spinal robot ics. Employment of enabling navigation and emerging technology with the registration of patient-specific anatomy enables clear delineation of anatomic landmarks and facilitation of a successful procedure. Additionally, avoidance of common pitfalls during use of naviga tion systems in ESS is discussed in this review.