Liang-Jie He

Background Open surgery is commonly used for treating benign bone tumours and tumour-like lesions near the joints of the extremities. However, inappropriate resection margins may lead to incomplete lesion removal and subsequent local recurrence, while overly extensive dissection aggravates soft tissue injury and compromises periarticular joint function. Although uniportal endoscopic technique have been well established in minimally invasive spinal surgery, their utilization in juxta-articular benign bone lesions remains poorly defined with unclear patient selection criteria and medium-term oncological performance. This retrospective study aimed to summarize the appropriate indications for uniportal endoscopic technique in the treatment of benign bone tumours and tumour-like lesions adjacent to limb joints and evaluate its oncological safety and local control outcomes. Purposes By comparing the differences between the uniportal endoscopic technique and open surgery in treating benign bone tumours and tumour-like lesions adjacent to limb joints, this study aims to investigate the feasibility of the uniportal endoscopic technique. More importantly, it aims to evaluate and discuss the indications of uniportal endoscopic technique, as well as the medium-term oncological efficacy and safety. Methods A retrospective analysis was conducted on the clinical data of patients with benign bone tumours and tumour-like lesions near the joints of the extremities treated at the Affiliated Cancer Hospital of Chongqing University between October 2021 and December 2024. Among them, 53 patients were treated using the uniportal endoscopic technique, and 97 patients were treated using the open surgery. The follow-up period for all cases exceeded 12 months. All cases had a definitive pathological diagnosis preoperatively. The lesion size (maximum diameter) was recorded for indication stratification. Primary study endpoints focused on medium-term oncological outcomes, including local recurrence rate and lesion clearance status evaluated by serial follow-up computed tomography (CT). Secondary perioperative indicators including operation time, intraoperative blood loss, postoperative complications, and preoperative and postoperative Visual Analogue Scale (VAS) scores were collected for comparison. Surgical outcomes were evaluated using the modified Macnab criteria. Results All 150 patients included in this study completed the follow-up examinations. During follow-up, adequate radical lesion clearance was confirmed on serial CT examinations in all patients, and no local recurrence was detected in both the uniportal endoscopic technique group and the open surgery group. All lesions enrolled in this study had a maximum diameter less than 5 cm, and uniportal endoscopic technique achieved complete resection in these eligible cases, suggesting that a maximal diameter < 5 cm represents a reasonable size indication for this endoscopic technique. Postoperative imaging examinations indicated satisfactory bone healing in all patients. The mean operation time was 140.02 ± 39.67 min in the uniportal endoscopic technique group and 141.56 ± 36.90 min in the open surgery group, with no statistically significant difference between the two groups (P > 0.05). Intraoperative blood loss was significantly lower in the uniportal endoscopic technique group compared with the open surgery group [20.00 (15.00) mL vs. 50.00 (50.00) mL; P < 0.001]. No postoperative complications occurred in either group. Intra-group comparison: The VAS scores at various postoperative time points were significantly lower compared to the preoperative scores in both groups (P < 0.05), indicating statistically significant improvement postoperatively. The results of the modified Macnab criteria at the final follow-up indicated significant improvement in clinical symptoms for all patients, suggesting postoperative pain relief, functional recovery, and improved quality of life. Conclusion In conclusion, for juxta-articular benign bone tumours and tumour-like lesions with a maximum diameter less than 5 cm, uniportal endoscopic technique achieves equivalent radical resection efficacy compared with open surgery under strict indication screening. No local recurrence was observed in either group during follow-up, which suggests the favourable oncological safety of the uniportal endoscopic technique. Although the uniportal endoscopic technique had advantages in several perioperative indicators, these minimally invasive benefits should not serve as the primary basis for surgical decision-making.

Benign lesions of the spine include benign tumors and tumor-like lesions of the spine, which usually occur in the thoracic and lumbar vertebrae. The incidence rate is low, accounting for about 1% of primary bone tumors. Few cases of endoscopic treatment of benign spinal lesions have been reported in the literature. Here, we introduce a new surgical technique using full endoscopy and allogeneic bone grafting to treat benign spinal lesions. All patients in this study successfully underwent the operation, and their pain was significantly relieved postoperatively. The patient VAS scores decreased from 3.07 ± 0.70 preoperatively to 0.33 ± 0.49 at the last follow-up visit (p < 0.05). The mean total blood loss (including drainage blood) was 16.67 ± 6.98 mL. The mean operative time was 63.33 ± 7.23 min. No patients developed numbness in the corresponding segmental distribution after surgery, none of the patients had serious postoperative complications, and none had focal recurrence during follow-up requiring reoperation. Patients reported symptom relief throughout the whole follow-up period. We believe that endoscopic surgery preserves the ligaments and soft tissues around the vertebral body, and that this technique is feasible with minimal trauma, rapid recovery, and good outcomes at short-term follow-up. This minimally invasive treatment modality offers a new option for the treatment of patients with benign spinal lesions.