Unilateral Biportal Endoscopic Spinal Surgery: Comparing Clinical Outcomes and Learning Curves between Novice and Experienced Surgeons

Abstract Background: Degenerative lumbar spinal stenosis can lead to neurological problems that may require surgical decompression. Recently, unilateral biportal endoscopy (UBE) is a novel, minimally invasive technique that can achieve effective decompression while preserving column stability. However, novice surgeons may face challenges in the localization and manipulation of the endoscope. Objectives: We compared the outcomes of UBE surgeries between novice and experienced surgeons, evaluating its suitability for clinical practice. Materials and Methods: We retrospectively enrolled 58 patients who underwent UBE decompression at our institution. Twenty-nine patients were operated on by a novice surgeon (the novice surgeon group) and the other 29 patients were operated on by an experienced surgeon (the experienced surgeon group). Data on gender, age, operative level, surgery duration, estimated blood loss, length of hospital stay, and follow-up duration were collected. Postoperative outcomes, including pain scores, functional ability, and complications, were compared. Results: The experienced surgeon group demonstrated shorter operation duration and hospital stay compared with the novice surgeon group. Both groups experienced improvements in postoperative leg pain, whereas there is no significant difference in comparison between the two groups. Oswestry Disability Index scores significantly improved after surgery in both groups, and the experienced surgeon group had significantly superior scores at the 3-month (14.90 ± 6.43 vs. 21.59 ± 11.54, P < 0.05) and 6-month follow-up (11.24 ± 5.46 vs. 15.10 ± 10.96, P < 0.05). Complications were observed in 3.3% of the experienced surgeon group (1 dural tear) and in 13.8% of the novice surgeon group (4 dural tears). After plotting the learning curve by cumulative sum analysis, the surgical technique reaches a plateau after 13 cases of operation in both groups. Conclusions: UBE offers promising clinical outcomes when performed by both novice and experienced surgeons. Consequently, UBE can be considered a suitable option for surgical decompression in degenerative lumbar spinal stenosis, even for surgeons new to endoscopic spine surgery.