Wei Zhang

Objective: Revision surgery for the removal of a migrated interbody fusion cage is challenging due to scar tissue formation in the surgical area. This study introduces a unilateral biportal endoscopic (UBE) technique for the removal of a migrated fusion cage and reports the patient's clinical outcomes. Methods: A unilateral lumbar interbody fusion (ULIF) was performed via a trans-facet approach to extract the posterior lumbar interbody cage, thereby bypassing scar tissue from prior surgeries. Results: The patient's clinical symptoms improved significantly postoperatively, with no complications such as nerve injury or cerebrospinal fluid leakage. At the six-month postoperative follow-up, the patient's lumbar and leg VAS scores showed significant improvement, with no obvious signs of cage loosening observed. Conclusion: UBE revision surgery may represent a safe and effective alternative for the removal of migrated posterior lumbar interbody cages.

The aim of this study was to explore and compare the clinical and radiographic outcomes of unilateral pedicle screw fixation (UPSF) and bilateral pedicle screw fixation (BPSF) in unilateral biportal endoscopic extreme transforaminal lumbar interbody fusion (UBE-eXTLIF) for the treatment of lumbar degenerative diseases. A total of 29 patients who underwent UBE-eXTLIF with either UPSF or BPSF were investigated retrospectively. The operation time, length of postoperative hospital stay, and complications were recorded. A visual analog scale (VAS) for low back pain and leg pain, the Oswestry Disability Index (ODI) and a modified Macnab scale were used to evaluate clinical efficacy. Radiographs and CT were utilized to assess radiological outcomes such as disc height (DH), lumbar lordosis (LL) and the interbody fusion rate. Both surgical techniques resulted in significant improvements in the VAS score and ODI. The VAS scores for low back pain and leg pain improved after the operation in both groups, and there were no statistically significant differences between the two groups at postoperative 1, 3, 6, 12, or 24 months (P > 0.05). The ODI scores improved after the operation in both groups, and there were no statistically significant differences between the two groups at postoperative 1, 3, 6, 12, or 24 months (P > 0.05). According to the modified Macnab scale at the final follow-up, 6 cases were excellent, 1 case was good, and 1 case was fair in the UBE-eXTLIF with UPSF group, while 16 cases were excellent, 2 cases were good, and 3 cases were fair in the UBE-eXTLIF with BPSF group, and the difference was not statistically significant between the two groups (P > 0.05). The fusion rate at 2 years post-surgery was similar: 100% for UBE-eXTLIF with UPSF and 90.5% for UBE-eXTLIF with BPSF. Both lumbar lordosis and disc height were restored 2 years postoperatively in both groups, and the changes in LL and DH from preoperative to postoperative 2 years were not significantly different between the two groups (P > 0.05). The incidence of complications did not significantly differ between the two groups (P > 0.05). However, compared with that of UBE-eXTLIF with BPSF, the operation time of UBE-eXTLIF with UPSF was shorter (P < 0.05), but there was no statistically significant difference between the two groups in terms of postoperative hospital stay (P > 0.05). In carefully selected patients, UBE-eXTLIF with unilateral posterior fixation may yield short-to-mid-term outcomes comparable to those of bilateral posterior fixation within a shorter operative time. However, owing to the small sample size, lack of biomechanical confirmation, and limited follow-up, the generalizability of these conclusions remains limited.

Abnormal accumulation of both intracellular and extracellular free nucleic acids drives chronic inflammation in intervertebral disc degeneration (IVDD). Despite the development of numerous minimally invasive treatments for IVDD, systematic approaches targeting the chronic inflammation mediated by both nucleic acid types are lacking. We propose a dual clearance strategy that inhibits mitochondrial DNA release inside nucleus pulposus cells while removing extracellular DNA from the disc microenvironment. Using single-cell sequencing and clinical samples, we revealed how both nucleic acid types drive inflammation. We then developed a targeted nanovesicle system delivering a mitochondrial membrane-stabilizing small molecule to block DNA leakage and inflammatory signaling, along with a hydrogel that captures extracellular DNA to prevent immune activation. In a rat model, this approach significantly slowed disease progression. This targeted dual nucleic acid clearance strategy provides a approach for treating IVDD and offers a theoretical framework for addressing other nucleic acid-related inflammatory diseases.

The technique of spinal decompression under endoscopy has been widely applied, but reports on endoscopic cervical fixation are rare. The unilateral biportal endoscopic (UBE) technique stands out for its lesser muscle intrusion and more flexible surgical approach. We applied the UBE approach for cervical fixation and laminectomy. We achieved bilateral lateral mass screw fixation by making an auxiliary UBE portal combined with the Roy-Camille and Magerl techniques. Our successful implementation of cervical fixation using the UBE technique at the C3/4 level suggests its efficacy. This approach is a valuable and minimally invasive option for cervical fixation.

Background: The traditional surgical procedures for upper lumbar disc herniation (ULDH) usually lead to frequent complications. We aim to investigate the clinical efficacy of the unilateral biportal endoscopy (UBE) technique in treating upper lumbar disc herniation (ULDH). Methods: From January 2020 to December 2021, the clinical data of 28 patients with ULDH treated with the UBE technique were collected and analyzed for surgery time under UBE, postsurgical drainage, postsurgical hospital stay, and complications. The clinical efficacy was evaluated according to the modified MacNab score, Oswestry disability index (ODI), and visual analogue scale (VAS) of low back pain and lower limb pain before the surgery; one week, one month, and three months after the surgery; and at the last follow-up. Results: All patients underwent the UBE surgery successfully. The surgery time under UBE for non-fusion cases was 47.50 ± 11.84 min (monosegment) and 75.00 ± 20.66 min (two segments), while that for fusion cases was 77.50 ± 21.02 min. The postsurgical drainage for non-fusion cases was 25.00 ± 13.94 mL (monosegment) and 38.00 ± 11.83 mL (two segments), while that for fusion cases was 71.25 ± 31.72 mL. The postsurgical hospital stay was 8.28 ± 4.22 days. The follow-up time was 15.82 ± 4.54 months. The VAS score for each time period after the surgery was significantly lower (P < 0.05), while the ODI was significantly higher than that before the surgery (P < 0.05). According to the modified MacNab scoring standard, the ratio of excellent to good was 96.43% at the last follow-up. Two patients experienced transient numbness and pain in their lower limbs and no activity disorder after the surgery, and they recovered after conservative treatment. Conclusions: The clinical effect of UBE technique in treating ULDH was reliable. According to the needs of the disease, the interlaminar approach or paraspinal approach of the UBE technique was selected. This technique took into account the effect of treatment, achieved the purpose of minimal invasiveness, and did not require special instruments. Therefore, it has the potential for clinical application.

Objective: Unilateral biportal endoscopy (UBE)is a minimally invasive spine surgery with reduced traumatization of the posterior lumbar ligament and muscular structures. This study reports contralateral translaminar approach with UBE for highly down-migrated lumbar disc herniation (LDH). Methods: Data of 32 patients with highly down-migrated LDH treated using UBE at our center from January 2020 to July 2022 were retrospectively analyzed. The operation time and perioperative complications were recorded, and the visual analog scale (VAS) of pain was recorded to evaluate the degree of lower back and extremity pain. The Oswestry disability index (ODI) was used to evaluate lumbar spine function. The modified MacNab score was used to evaluate clinical efficacy. Results: All patients successfully underwent the operation, with a time range from 47 to 65 min and an average operation time of 56.09 ± 5.11 min. Overall, 17 and 15 were males and females, respectively, with ages ranging from 34 to 72 years and an average age of 56 ± 7.89 years. The postoperative follow-up period was 12–18 months, with an average of 14.9 ± 2.3 months. The postoperative lower back VAS pain score and ODI were statistically significant compared with preoperatively (P < 0.05). At the final follow-up, according to the modified Macnab criteria, 90.6% of cases were classified as good or excellent. Conclusion: UBE treatment of highly down-migrated LDH through the contralateral translaminar approach is safe and efficient. Therefore, this approach can be an efficient alternative for patients with highly downward-migrating LDH.