Unilateral Biportal Endoscopic Spine Surgery: Managing Complex and Revision Cases With a Minimally Invasive Approach

Revision spinal surgeries present challenges due to complications from previous surgeries, such as scar tissue and altered anatomy. Unilateral biportal endoscopic (UBE) spine surgery is a versatile, minimally invasive technique that can effectively address a wide range of spinal pathologies, including complex and revision cases. This case series aimed to evaluate the safety and efficacy of UBE spine surgery in managing complex and revision spinal cases by retrospectively reviewing three challenging cases managed with UBE surgery. These included a cervical spine revision, a lumbar spine revision, and a complex thoracolumbar pathology in an elderly patient. Each case was evaluated for clinical outcomes, including visual analog scale (VAS) scores, neurological function, and overall patient satisfaction. Case 1 involved a 45-year-old female patient with persistent radicular pain after anterior cervical discectomy and arthroplasty. UBE decompression resulted in complete pain relief (VAS 8/10 to 0/10) at the two-year follow-up. Case 2 was of a 49-year-old male patient with cauda equina syndrome post-L5/S1 posterior lumbar interbody fusion (PLIF), who showed marked improvement in left foot power (0/5 to 4/5) and reduced VAS scores (9/10 to 1/10) at the six-month follow-up. Case 3 involved a 71-year-old female patient with pathological fractures and multiple comorbidities, where UBE cord decompression, kyphoplasty, and screw fixation performed under local anesthesia resulted in significant pain relief (VAS 0-1/10) and improved mobility at the two-year follow-up. This case series showcases the versatility of UBE surgery in managing complex and revision spinal cases, with excellent clinical outcomes, especially in patients with significant comorbidities.