A multidimensional analysis of the clinical advantages of unilateral biportal endoscopy in the treatment of severe thoracic lateral fibrous band ossification

Retrospective cohort study with propensity score matching. Severe thoracic yellow ligament ossification (TOLF) can lead to severe thoracic spinal cord disease. Traditional open surgery is associated with significant trauma and high risk of complications. As a minimally invasive technique, unilateral double-channel endoscopic (UBE) surgery has demonstrated multidimensional clinical advantages in treating severe TOLF, but its efficacy requires systematic validation.To compare the clinical efficacy, imaging decompression, and perioperative indicators between UBE and traditional open posterior total laminectomy decompression for severe TOLF. A retrospective study included 112 patients with severe TOLF (tuberculous osteomyelitis with spinal canal invasion ≥ 50%) admitted from January 2019 to December 2024. After propensity score matching, 42 cases were assigned to the UBE group and 42 to the open surgery group. Primary outcomes included the modified Japanese Orthopaedic Association (mJOA) score at 12 months postoperatively, recovery rate, and minimum clinically important difference (MCID) achievement rate. Secondary outcomes comprised operative time, blood loss volume, length of hospital stay, dural sac cross-sectional area (DSCA) expansion rate, and incidence of dural tear. The UBE group demonstrated significantly superior postoperative mJOA scores (8.2 ± 0.9 vs. 6.9 ± 1.1), recovery rates (43.2% vs. 26.3%), and MCID achievement rates (88.1% vs. 61.9%) compared to the open group (all P < 0.01). Surgical duration, blood loss, and hospitalization days were markedly reduced ( P < 0.001). The DSCA dilation rate was higher (228.4% vs. 184.5%, P < 0.001), while the incidence of dural tear was lower (4.8% vs. 11.9%, P > 0.05). UBE technique for treating severe TOLF can significantly promote neurological function recovery, reduce surgical trauma, and achieve more comprehensive imaging decompression, making it a safe and effective minimally invasive treatment option.