Background: Traumatic spinal cord injury (TSCI) is a highly fatal and disabling event, and its incidence rate is increasing in China. Therefore, we collated the epidemiological factors of TSCI in different regions of China to update the earlier systematic review published in 2018.Method: We searched four English and three Chinese electronic databases from 1978 to October 1, 2022. From the included reports, information on sample characteristics, incidence, injury characteristics, prognostic factors, and economic burden was extracted. The selection of data was based on the PRISMA statement. The quality of the included studies was assessed by the Agency for Healthcare Research and Quality (AHRQ) tool. The results of the meta-analysis were presented in the form of pooled frequency and forest plots.Results: A total of 59 reports (60 studies) from 23 provinces were included, of which 41 were in the Chinese language. The random pooled incidence of TSCI in China was estimated to be 65.15 per million (95% CI: 47.20–83.10 per million), with a range of 6.7 to 569.7 per million. The pooled male-to-female ratio was 1.95:1. The pooled mean age of the cases at the time of injury was 45.4 years. Motor vehicle accidents (MVAs) and high falls were found to be the leading causes of TSCI. Incomplete quadriplegia and AISA/Frankel grade D were the most common types of TSCI. Cervical level injury was the most prevalent. The pooled in-hospital mortality and complication rates for TSCI in China were 3% (95% CI: 2–4%) and 35% (95% CI: 23–47%). Respiratory problems were the most common complication and the leading cause of death.Conclusion: Compared with previous studies, the epidemiological data on TSCI in China has changed significantly. A need to update the data over time is essential to implement appropriate preventive measures and formulate interventions according to the characteristics of the Chinese population.

Objectives: To compare the short-term outcomes of unilateral biportal endoscopic lumbar interbody fusion (BLIF) and uniportal endoscopic lumbar interbody fusion (ULIF). Methods: Sixty patients diagnosed with L4/5 spinal stenosis who underwent BLIF and ULIF were included (30 in each group). Clinical evaluation was performed preoperatively and postoperatively in the 1st week, 1st month, and 1st year. Factors such as the visual analogue score (VAS), Oswestry Disability Index (ODI), operative time, surgical complications, and radiological outcomes (fusion rate, screw loosening, and cage subsidence) were compared between the two groups. Results: All patients showed improved mean VAS and ODI at all three postoperative follow-ups, and no statistically significant differences were detected between the BLIF and ULIF groups. The mean operative time in the BLIF group was shorter than that in the ULIF group. Nerve root injury occurred in two patients in the BLIF group, while leakage of cerebrospinal fluid occurred in one patient in the ULIF group. All adverse events were treated adequately prior to discharge. The fusion rates with definite and probable grades were significantly higher in the BLIF group than that in the ULIF group. One case of cage subsidence with no screw loosening occurred in each group. Conclusion: Both BLIF and ULIF are safe and effective surgical techniques. Compared with ULIF, BLIF has the advantages of shorter operative time and a higher fusion rate. Other merits of BLIF include a wider surgical field, greater maneuverability of instruments, visibility during cage implantation, and transverse orientation of the cage.

Unilateral biportal endoscopy (UBE) with unilateral laminotomy for bilateral decompression (ULBD) is an essential neurosurgical procedure for the treatment of lumbar spinal stenosis. This technique offers significant advantages over traditional full laminectomy and spinal fusion fixation, providing surgeons with greater operational freedom and precision in decompression. The UBE-ULBD procedure stands out because of its distinct working and observation channels, which significantly augment the surgeon's maneuverability. The process begins by marking two 1-cm incisions, approximately 1 cm away from the midpoint of the cranial and caudal extents at the target intervertebral space, using the intersection of the surgical side's laminar gap with the puncture needle as a central reference. This methodical approach ensures that the bilateral channels are interconnected at the laminar gap. After this, meticulous dissection of the soft tissues encircling the laminar gaps for both channels is performed using specialized separation instruments, guaranteeing a clear passage between the observation and working channels. The endoscope is then meticulously positioned within the left observation channel, integrating it with a light source, high-definition imaging system, and an irrigation line for optimal visualization. On the right side, the working channel is adeptly used with a nucleotome and radiofrequency ablation electrode to meticulously remove soft tissues. This step is crucial for exposing the superior edge of the inferior lamina, the laminar gap itself, and the inferior edge of the superior lamina, thereby achieving effective bilateral decompression (Figure 1).Characterized by minimal incisions and rapid postoperative recovery, UBE-ULBD achieves favorable clinical outcomes.^1-3 In Video 1, we present an endoscopic operation of single-segment lumbar decompression via the posterior approach using UBE-ULBD. Additionally, we conducted a retrospective study of 25 patients with lumbar spinal stenosis treated with UBE-ULBD to evaluate the practicality of this technique (Table 1). The mean (standard deviation) operative time for the UBE-ULBD group was 58.44 (6.60), with significant improvements in Oswestry Disability Index and visual analog scale scores at 12 months postoperatively (from 54.21 [5.27] to 10.17 [2.73], and from 5.00 [1.06] to 1.67 [1.65], respectively, P < 0.05). Microdiscectomy ULBD, unilateral uniportal endoscopic with ULBD, and UBE-ULBD are the 3 main surgical approaches for treating bilateral symptoms of lumbar spinal stenosis. Choi et al. ¹ suggest that there is no statistically significant difference in postoperative visual analog scale and Oswestry Disability Index scores among the 3 techniques. However, microdiscectomy ULBD is associated with more pronounced trauma, including denervation pain of muscles. The percutaneous endoscopic ULBD offers shorter operative times and less muscle trauma and blood loss, which may have a multifaceted positive impact on postoperative recovery and symptom alleviation for patients.

Objective: Spinal endoscopic surgery has been promoted rapidly in the past decade, attracting an increasing number of young, dedicated surgeons. However, it has long been denounced for its long learning curve as a factor impeding the development of this state-of-the-art technique. The aim of the present study was to discover what really matters in the educational process of becoming a spinal endoscopic surgeon.Methods: An online survey consisting of 14 compulsory questions was distributed in April and May 2022 through the First Chinese Spinal Endoscopic Surgeons Skills Competition. Reminders were sent to increase response rates.Results: Of the 893 emails that were sent, we received 637 responses. A total of 375 (76.7%) surgeons most frequently used endoscopic techniques in their practices. Regardless of their different backgrounds, 284 (75.7%) surgeons thought it would be necessary for a young spinal endoscopic surgeon to perform 300 cases independently in order to become proficient, followed by 500 (n=43, 11.5%), 100 (n=40, 10.7%), and 1,000 (n=8, 2.1%) cases. According to the surgeons, the most difficult aspect of mastering the endoscopic technique is a disparate surgical view (n=255, 68%), followed by adaption to new instruments (n=86, 22.9%) and hand-eye coordination (n=34, 9.1%). The most helpful training method for helping the spinal endoscopic surgeons of younger generations improve is operating on simulation models or cadaver courses (n=216, 57.6%), followed by online or offline theoretical courses (n=67, 17.9%), acquiring opportunities during surgeries (n=51, 13.6%), and frequently participating in surgeries as an assistant (n=41, 10.9%).Conclusion: From the perspective of surgeons, to be skilled in spinal endoscopic surgery means overcoming a steep learning curve. However, training systems should be given more attention to make them more accessible to younger surgeons so they can work on simulation models or take cadaver courses.