Clinical efficacy of unilateral biportal endoscopic spinal decompression for lumbar intraspinal pneumatosis

<title>Abstract</title> Study design: Retrospective observational study. Objective To analyze the short-term clinical efficacy of unilateral biportal endoscopic (UBE) spinal decompression in the treatment of lumbar intraspinal pneumatosis. Background Lumbar intraspinal pneumatosis is extremely rare with an incidence of 0.15%, mainly caused by intervertebral disc degeneration. It compresses nerve roots, causing low back and radicular pain, and often requires surgery when conservative treatment fails. Unilateral biportal endoscopic technology offers advantages like clear visualization and flexible manipulation, but its application in this condition remains underreported. Methods Five patients with a mean age of 69.0 ± 3.8 years and symptomatic lumbar intraspinal pneumatosis who underwent unilateral biportal endoscopic surgery between May 2022 and June 2024 were analyzed. Perioperative parameters including operation time, hospital stay and complications were recorded. The Visual Analogue Scale (VAS) was used to assess low back pain and lower extremity pain, the Oswestry Disability Index (ODI) to evaluate lumbar spine function, and the MacNab criteria to assess clinical efficacy. Results All surgeries succeeded with a mean operation time of 57.0 ± 9.3 minutes and a mean hospital stay of 4.2 days, and no complications occurred. At 1 day, 3 months, and 6 months postoperatively, Visual Analogue Scale scores for low back and leg pain as well as Oswestry Disability Index scores were significantly lower than preoperative values ( <italic>P</italic> &lt; 0.001). At 6 months postoperatively, MacNab excellent and good rate was 100%. Conclusion UBE for the treatment of lumbar intraspinal pneumatosis has the advantages of minimal trauma, clear field of vision, flexible operation, and rapid postoperative recovery, representing a potentially safe and effective option.