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.

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.

Objective: The objective of this study was to introduce a surgical technique for the percutaneous decompression of cervical stenosis (CS) using a unilateral biportal endoscopic approach and characterize its early clinical and radiographic results. Materials and Methods: Nineteen consecutive patients with CS who needed surgical intervention were recruited. All enrolled patients underwent unilateral biportal endoscopic laminectomy (UBEL). All patients were followed postoperatively for >1 year. The preoperative and final follow-up evaluations included the Japanese Orthopedic Association (JOA) score for neurological assessment, visual analogue scale (VAS) for axial pain and C2–C7 Cobb angle for cervical sagittal alignment. The postoperative complications were analyzed. Results: Thirteen males and six females were included in the analysis. The mean follow-up period was 16.3 ± 2.6 months. The mean operative time was 82.6 ± 18.4 min. Postoperative MRI and CT revealed ideal neural decompression of the treated segments in all patients. Preoperative VAS and JOA scores improved significantly after the surgery, and cervical lordosis was preserved on the postoperative images. Conclusions: UBEL was an effective surgical method for CS, which may also minimize iatrogenic damage to the posterior tension band (PTB) and help to maximize the preservation of the cervical lordosis.

Rationale: Biportal endoscopic revision surgery for adjacent segmental disease (ASD) after lumbar arthrodesis is seldomly reported. Herein, we present 3 cases of ASD with radiculopathy wherein satisfactory results were obtained using unilateral biportal endoscopic (UBE) decompression. Patient concerns: Case 1 was of a 56-year-old male who presented with a chief complaint of Intermittent claudication since 2-year. Case 2 involved a 78-year-old female who was admitted to the hospital with a chief complaint of radiating pain and weakness in the left leg for at least 1 year. Case 3 was a 67-year-old woman who visited our hospital because of radiating leg pain for 5 months. All the cases had a history of L4 to L5 lumbar interbody fusion surgery. Diagnoses: Computed tomography and magnetic resonance imaging showed the spinal epidural lipomatosis at the L3 to L4 level in case 1, the up-migrated lumbar disc herniation at L3 to L4 level in case 2 and unilateral foraminal stenosis at the L5 to S1 level in case 3. Interventions: Under UBE guidance, the ipsilateral approach was used to treat adjacent lumbar stenosis caused by spinal epidural lipomatosis. The contralateral approach was used to remove the up-migrated herniated disc. The paraspinal approach was applied to decompress the foraminal stenosis. Outcomes: Postoperative parameters were improved clinically, and nerve roots were decompressed radiologically. No complications were developed. Lessons: UBE revision surgery showed a favorable clinical and radiological result without complications and may be a safe and effective alternative technique for ASD.

Objective: To compare clinical and radiological outcomes of single vs. double cage insertion in unilateral biportal endoscopic lumbar interbody fusion (UBE-LIF) for lumbar degenerative diseases (LDD). Methods: This retrospective study analyzed 103 LDD patients undergoing UBE-LIF from June 2021 to June 2023, with 1:3 matching for age, sex, and operative level, forming unilateral cage (Group S, n = 51) and bilateral cage (Group D, n = 17) groups. Outcomes included fusion rates (assessed by lumbar CT at 1 and 2 years), perioperative metrics (surgical time, estimated blood loss [EBL], hospital stay), postoperative cage subsidence, complications, and patient-reported outcomes (VAS back/leg, ODI, SF-12 PCS). Statistical analyses used Student's t-tests and Fisher's exact tests ( p < 0.05). Results: Groups were similar in age, sex, BMI, smoking status, diabetes, and fusion level, except Group D had lower BMD (−1.7 ± 0.3 vs. −1.3 ± 0.5, p = 0.005). Group D had longer surgical time (204.1 ± 36.1 vs. 157.6 ± 16.2 min, p < 0.001) and higher EBL (150.0 ± 76.8 vs. 106.8 ± 26.8 mL, p = 0.001). Postoperative cage subsidence was significantly more frequent in the single-cage group (17/51, 33.3%) than in the double-cage group (1/17, 5.9%; p = 0.029). Fusion rates were comparable at 1 year (94.1% vs. 88.2%, p = 0.675) and 2 years (100% vs. 98.0%, p = 1.000), with Group D showing a numerically higher 1-year rate. Group D had lower VAS back scores at 6 months (1.8 ± 0.9 vs. 2.4 ± 1.0, p = 0.041). Complication rates and hospital stay were similar. Conclusion: Single-cage UBE-LIF offers comparable fusion rates and clinical outcomes with reduced surgical time and blood loss, despite a higher incidence of cage subsidence. Double-cage insertion may provide advantages in early stability and lower subsidence risk, making it preferable in select patients with lower BMD. Both techniques yield favorable long-term results in UBE-LIF for lumbar degenerative diseases.

Background and objective: Postoperative delirium (POD) is a frequent and severe complication among elderly patients undergoing hip fracture surgery, but its pathogenic mechanisms remain understood. This study analyzed gut microbiota composition in elderly hip fracture patients who developed POD, aiming to explore preliminary microbial associations for future hypothesis-driven research. Materials and methods: A 1:1:1 case-control study enrolled 30 elderly patients undergoing hip fracture surgery under general anesthesia: 10 with POD, 10 without POD, and 10 healthy elderly controls. Fecal specimens were analyzed using 16S rRNA gene sequencing. Alpha diversity, beta diversity, taxonomic relative abundance, and LEfSe analysis were evaluated. Results: No significant intergroup differences were found in alpha diversity indices (P>0.05), although Chao1 and Shannon indices were relatively higher in controls. Beta diversity differed significantly among the three groups (PERMANOVA, P = 0.001), but not between POD and non-POD groups (P>0.05), suggesting the overall difference was mainly driven by the contrast between healthy controls and surgical patients. Controls had markedly higher relative abundances of Lactobacillus and Pseudobutyribrio than the two surgical groups, though this may partly reflect fracture, surgery, and hospitalization rather than POD-specific dysbiosis. Compared with the non-POD group, the POD group showed significant enrichment in Erysipelotrichales, Erysipelotrichaceae, Lachnospiraceae, and Atopobium, while the non-POD group had elevated Verrucomicrobiaceae and Lactobacillaceae. LEfSe identified Lactobacillus, Vibrionaceae, and Shigella as key differential taxa in the non-POD group, whereas Lachnospiraceae, Erysipelotrichaceae, Collinsella, and Helicobacter were closely correlated with the POD group. Discussion and implications: Alpha diversity did not differ significantly among the three groups, whereas beta diversity differed markedly. The POD group exhibited decreased relative abundance of taxa generally regarded as commensal (e.g., Lactobacillus) and increased abundance of taxa previously associated with inflammation (e.g., Erysipelotrichaceae, Collinsella), while healthy controls showed higher commensal taxa. However, 16S rRNA sequencing provides taxonomic information only and cannot directly demonstrate microbial function or inflammatory activity. These findings suggest that gut dysbiosis may contribute to POD pathogenesis through the gut-brain axis, offering preliminary insights for future hypothesis-driven research. The main limitation is the relatively small sample size, and further validation in larger cohorts is warranted.