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

PurposeTo compare the clinical outcomes of percutaneous transforaminal endoscopic discectomy (PTED) and unilateral biportal endoscopic discectomy (UBE) for the treatment of single-level lumbar disc herniation (LDH).Materials and methodsFrom January 2020 to November 2021, 62 patients with single-level LDH were retrospectively reviewed. All patients underwent spinal surgeries at the Affiliated Hospital of Chengde Medical University and Beijing Tongren Hospital, Capital Medical University. Among them, 30 patients were treated with UBE, and 32 were treated with PTED. The patients were followed up for at least one year. Patient demographics and perioperative outcomes were reviewed before and after surgery. The Oswestry Disability Index (ODI), visual analog scale (VAS) for back pain and leg pain, and modified MacNab criteria were used to evaluate the clinical outcomes. x-ray examinations were performed one year after surgery to assess the stability of the lumbar spine.ResultsThe mean ages in the UBE and PTED groups were 46.7 years and 48.0 years, respectively. Compared to the UBE group, the PTED group had better VAS scores for back pain at 1 and 7 days after surgery (3.06 ± 0.80 vs. 4.03 ± 0.81, P < 0.05; 2.81 ± 0.60 vs. 3.70 ± 0.79, P < 0.05). The UBE and PTED groups demonstrated significant improvements in the VAS score for leg pain and ODI score, and no significant differences were found between the groups at any time after the first month (P > 0.05). Although the good-to-excellent rate of the modified MacNab criteria in the UBE group was similar to that in the PTED group (86.7% vs. 87.5%, P > 0.05), PTED was advantageous in terms of the operation time, estimated blood loss, incision length, and length of postoperative hospital stay.ConclusionsBoth UBE and PTED have favorable outcomes in patients with single-level LDH. However, PTED is superior to UBE in terms of short-term postoperative back pain relief and perioperative quality of life.

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“…Therefore, the learning curve of UBE is relatively flat and short. Xu demonstrated that the learning curve for mastering UBE is 54 cases ( 29 ).…”

Section: Discussionmentioning

confidence: 99%

Clinical comparison of percutaneous transforaminal endoscopic discectomy and unilateral biportal endoscopic discectomy for single-level lumbar disc herniation

Cheng

Bao

et al. 2023

Front. Surg.

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“…Although the surgical complication rate was similar between ULIF and conventional procedures (ULIF vs. MI-TLIF, 6.9 vs. 6.7%; ULIF vs. PLIF, 6.8% vs. 5.1%), the slightly higher incidence of dural tear in the ULIF group should be noted (ULIF vs. MI-TLIF, 4.8% vs. 2.1%; ULIF vs. PLIF, 4.7% vs. 2.8%). Therefore, ULIF is recommended for surgeons who have performed at least 54 cases of biportal endoscopic decompression ( 70 ). Another complication was the epidural hematoma, most likely due to oozing from the bone trapped under the intact posterior tension band, which usually could be resolved by itself ( 32 ).…”

Section: Discussionmentioning

confidence: 99%

Unilateral biportal endoscopic lumbar interbody fusion enhanced the recovery of patients with the lumbar degenerative disease compared with the conventional posterior procedures: A systematic review and meta-analysis

Yang

Cheng²,

Hai³

et al. 2023

Front. Neurol.

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BackgroundMinimally invasive endoscopic technique is an important component of Enhanced Recovery After Surgery (ERAS) protocol for neurosurgery. In recent years, unilateral biportal endoscopic lumbar interbody fusion (ULIF) has been used in the treatment of lumbar degenerative diseases (LDD). This study aims to investigate whether ULIF could enhance the recovery of patients with LDD compared with the conventional minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) or posterior lumbar interbody fusion (PLIF).MethodsA comprehensive literature search was performed for relevant studies in PubMed, EMBASE, Web of Science, Cochrane Library database, China National Knowledge Internet, and Wanfang database. Surgical data, clinical outcomes, radiographic outcomes, and surgical complications were compared between patients with LDD who underwent ULIF and those who underwent conventional MI-TLIF or PLIF.ResultsNotably, 12 studies, comprising 981 patients with LDD, were included. Of these patients, 449 underwent ULIF and 532 patients (355 MI-TLIF and 177 PLIF) were treated with conventional procedures. There was no significant difference in the fusion rate, cage subsidence rate, and surgical complications between the ULIF group and the MI-TLIF or PLIF group. Compared with MI-TLIF, the ULIF group presented a significantly reduced estimated blood loss (EBL) (WMD, −106.00; 95% CI −140.99 to −71.10, P < 0.001) and shorter length of hospital stay (LOS) (WMD, −1.27; 95% CI −1.88 to −0.66, P < 0.001); better short-term improvement in ODI (WMD, −2.12; 95% CI −3.53 to −0.72, P = 0.003) and VAS score for back pain (VAS-BP) (WMD, −0.86; 95% CI −1.15 to −0.58, P < 0.001) at 1 month post-operatively. Compared with PLIF, the ULIF group presented a significantly reduced EBL (WMD, −149.22; 95% CI −284.98 to −13.47, P = 0.031) and shorter LOS (WMD, −4.40; 95% CI −8.04 to −0.75, P = 0.018); better short-term improvement in VAS-BP (WMD, −1.07; 95% CI −1.77 to −0.38, P = 0.002) and VAS score for leg pain (VAS-LP) (WMD, −0.40; 95% CI −0.72 to −0.08, P = 0.014) at 1–2 week post-operatively; enhanced short- and long-term improvement in ODI at 1 month post-operatively (WMD, −3.12; 95% CI −5.72 to −0.53, P = 0.018) and the final follow-up (WMD, −1.97; 95% CI −3.32 to −0.62, P = 0.004), respectively.ConclusionCompared with conventional MI-TLIF and PLIF, ULIF was associated with reduced EBL, shorter LOS, and comparable fusion rate as well as complication management. Compared with MI-TLIF, a better short-term improvement in VAS-BP and ODI was achieved by ULIF; compared with open PLIF, additional enhanced short-term improvement in VAS-LP and long-term improvement in ODI were observed in ULIF. ULIF could enhance the recovery of patients with LDD compared with conventional posterior procedures.Systematic trial registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?RecordID=230695, CRD42021230695.

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“…Ultimately, 7 articles were included in the meta-analysis, with a total sample size of 760 cases, including 398 cases in the UBE group and 362 cases in the control group. The basic characteristics of the included literature are shown in Table 1 (14)(15)(16)(17)(18)(19)(20).…”

Section: Basic Characteristics Of the Included Studiesmentioning

confidence: 99%

Efficacy and safety of unilateral biportal endoscopic discectomy and conventional endoscopic discectomy in the treatment of lumbar disc herniation: a systematic review and meta-analysis

et al. 2023

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Background: Unilateral double-port endoscopic (UBE) discectomy is a newly invented surgical procedure for the treatment of lumbar disc herniation (LDH). As it has been on the market for a relatively short period of time, the lack of systematic analysis of the clinical efficacy and safety of the treatment of LDH is unclear.In this study, we compare randomised controlled trials to assess the clinical efficacy and safety of UBE and conventional endoscopic discectomy for LDH. Methods:The Chinese National Knowledge Infrastructure, Wanfang, PubMed, Embase, Cochrane library, and Chinese Biomedical databases were searched (from database inception to October 2022). The quality of included studies was assessed according to the Cochrane Risk Manual. The intervention of the UBE group was UBE discectomy, and the control measure was conventional endoscopic discectomy. The outcome indicators included hospital stay, the visual analogue score (VAS), intraoperative bleeding, the Oswestry dysfunction index (ODI), and complications. The data were analyzed using RevMan 5.4. Results:In total, 7 studies were included. Intraoperative bleeding was higher in the control group than in the UBE group (MD =−0.07; 95% confidence interval (CI): −0.21 to 0.08; P=0.14). The improvement of ODI score in the UBE group was significantly better (MD =0.13, 95% CI: −0.06 to 0.32; P=0.17). There was no statistical heterogeneity in terms of postoperative complications (I 2 =0%, P=1.00). The complication rate in the UBE group was lower (MD =0; 95% CI: −0.15 to 0.15; P=1.00). Postoperative VAS improvement in UBE group was significantly better (MD =−0.12; 95% CI: −0.27 to 0.03; P=0.11). The length of hospital stay in UBE group was shorter (MD =−2.04; 95% CI: −2.23 to −1.84; P<0.05). The t value of hospitalization length, VAS, Intraoperative bleeding, ODI and complicationswere 0.000-0.081, v was 20-26, all P>0.05, suggesting that this conclusion was stable.Conclusions: Patients in the UBE group spent less time in the hospital than the control group, and UBE group patients also woke up earlier than the control group. Therefore, UBE discectomy has certain reference value and can be popularized in clinic.

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

Cited by 45 publications

References 42 publications

Clinical comparison of percutaneous transforaminal endoscopic discectomy and unilateral biportal endoscopic discectomy for single-level lumbar disc herniation

Clinical comparison of percutaneous transforaminal endoscopic discectomy and unilateral biportal endoscopic discectomy for single-level lumbar disc herniation

Unilateral biportal endoscopic lumbar interbody fusion enhanced the recovery of patients with the lumbar degenerative disease compared with the conventional posterior procedures: A systematic review and meta-analysis

Efficacy and safety of unilateral biportal endoscopic discectomy and conventional endoscopic discectomy in the treatment of lumbar disc herniation: a systematic review and meta-analysis

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