Objective: This study aimed to review the current evidence on endoscopic techniques used in anterior cervical discectomy and fusion (ACDF) for degenerative cervical disease, with a focus on technical characteristics, clinical outcomes, complications, and fusion.Methods: PubMed/MEDLINE, Embase, Scopus, Web of Science, the Cochrane Library, and Google Scholar were systematically searched for the period from January 2000 to April 2026 in accordance with the 2020 PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines. Clinical studies of endoscopic techniques used in ACDF were eligible for inclusion. Full-endoscopic procedures were distinguished from endoscope-assisted procedures on the basis of the role of the endoscope and instrumentation. Data were synthesized qualitatively, and the ROBINS-I (Risk of Bias in Non-randomized Studies of Interventions) tool was used to assess risk of bias. Substantial clinical and methodological heterogeneity precluded meta-analysis.Results: The review included 7 retrospective studies with 502 patients, 264 of whom underwent ACDF using endoscopic techniques. Techniques varied considerably and included mini-open endoscopic assistance, water-mediated techniques, air-water switching, and hybrid endoscopic techniques. Reported complication rates ranged from 0% to 18.2%; fusion rates, when explicitly reported, ranged from 90% to 100%. Most studies reported favorable early clinical and radiographic outcomes. Interpretation was nevertheless limited by heterogeneity in techniques and comparators, inconsistent outcome assessment, variable follow-up, and moderate-to-serious risk of bias.Conclusion: Endoscopic techniques used in ACDF appear technically feasible and have yielded encouraging early outcomes. Full-endoscopic and endoscope-assisted procedures are technically distinct, however, and the current evidence does not establish superiority over conventional ACDF. Standardized terminology and high-quality prospective studies are needed.
Objective: Unilateral biportal endoscopy (UBE) and endoscopic spine surgery (ESS) are minimally invasive techniques, but their integration into routine surgical practice remains variable. Factors influencing global adoption, particularly cost, training, reimbursement, and institutional support, remain incompletely characterized. This survey study evaluated ESS practice perspectives among members of 2 international UBE societies, focusing on surgeon expertise, reimbursement models, training exposure, and perceived barriers.Methods: An electronic survey was developed and distributed to spine surgeons affiliated with the European Society of Unilateral Biportal Endoscopy Association and World Unilateral Biportal Endoscopy-America. The questionnaire assessed surgeon demographics, ESS experience, reimbursement patterns, cost-related barriers, training exposure, and expectations for future ESS use. Descriptive statistics were used to summarize response patterns, and subgroup differences were assessed by region.Results: Seventy-eight surgeons responded, most of whom were orthopedic surgeons (60.3%) practicing primarily in private hospitals (57.7%). Half of respondents had 1–5 years of ESS experience, and 34.6% had less than 1 year of experience. Lumbar pathology was treated with ESS by all respondents (100%), whereas cervical (47.4%) and thoracic (38.5%) ESS were less common. Only 7.7% of respondents reported that insurance coverage for ESS was “very easy.” Key barriers included startup costs, limited hospital support, and reimbursement challenges. Nevertheless, 42.3% of respondents reported “very high” patient interest, 41.0% reported “very high” surgeon interest, and 55.1% were “very optimistic” about ESS growth in their country over the next 5 years.Conclusion: This survey identified substantial optimism regarding ESS among members of UBE-focused societies, despite persistent barriers related to training limitations, inadequate reimbursement, and high capital investment. These findings may not be generalizable because the survey was limited to selected UBE-focused societies and did not evenly represent all geographic regions. Expanding formal ESS training, reducing capital and disposable costs, and refining reimbursement models may support broader adoption.
Cervical dumbbell schwannomas are usually managed with open or minimally invasive microsurgical approaches, and endoscopic removal of these tumors has not been previously reported. To our knowledge, this is the first case series describing the feasibility of unilateral biportal endoscopic (UBE) removal of cervical dumbbell schwannomas. Two consecutive patients with cervical dumbbell schwannomas presenting with hemiparesis underwent UBE removal. After laminotomy and medial facetectomy, the extradural tumor was first entered through epineurial and perineurial incisions and disconnected in the subperineurial space. The tumor was then dissected and removed along the established subperineurial plane. The intradural component was subsequently delivered through the dural sleeve from the extradural side. All steps were performed through the same biportal incisions using a dual-tower setup. No instrumented fusion was required. Gross total resection was achieved in one case, and subtotal resection with a residual intradural lesion was achieved in the other. Both patients had full neurological recovery. Asymptomatic occlusion of the nondominant vertebral artery occurred in one case. No cerebrospinal fluid leak, pseudomeningocele, or wound complication was observed. Both patients were followed for more than 1 year, with no tumor recurrence or progression. In the subtotal resection case, the residual intradural lesion was treated with adjuvant stereotactic radiosurgery. This case series demonstrates the technical feasibility of UBE removal of cervical dumbbell schwannomas without instrumented fusion. However, the present experience also highlights important limitations, including vertebral artery occlusion and incomplete intradural removal in a 2-patient series. This approach should therefore be regarded as an emerging technique that requires further refinement of surgical technique and instrumentation rather than as an established alternative.
To introduce a novel expandable-first, polyetheretherketone (PEEK)-second hybrid dual-cage technique, termed the “Lifting-Jack” technique, for unilateral biportal endoscopic transforaminal lumbar interbody fusion (UBE-TLIF) and to evaluate its early clinical and radiographic outcomes. This technical note and illustrative case series included 3 patients with single-level L4–5 degenerative spondylolisthesis who underwent UBE-TLIF using the Lifting-Jack technique. In this procedure, an expandable cage is first used as a controlled distractor, followed by insertion of a contralateral PEEK cage. Partial recompression is then performed to optimize cage-endplate conformity and load sharing. Clinical outcomes, including visual analogue scale (VAS) and Oswestry Disability Index (ODI) scores, were assessed preoperatively and up to 12 weeks postoperatively. Radiographic parameters, including anterior disc height, posterior disc height, segmental lordosis, and foraminal height, were also analyzed. All 3 patients showed rapid and sustained improvements in pain and function, with near-complete resolution of pain and marked improvement in disability by 12 weeks. Radiographic assessment showed consistent restoration of disc height, improved segmental lordosis, and increased foraminal height. No cage subsidence, cage migration, or perioperative complications were observed. The Lifting-Jack technique is a novel hybrid dual-cage strategy for UBE-TLIF that enables controlled disc-space distraction and facilitates safe PEEK cage insertion, with promising early clinical and radiographic outcomes. However, larger studies with longer follow-up are needed to confirm its safety, reproducibility, and durability.
Objective: Thoracolumbar burst fractures with neurological deficits remain surgically challenging, particularly when retropulsed fragments cause severe spinal canal compromise. This study evaluated the feasibility and clinical outcomes of unilateral biportal endoscopic (UBE) transpedicular decompression combined with percutaneous stabilization for neurologically symptomatic thoracolumbar burst fractures.Methods: A retrospective review was conducted in 13 consecutive patients with thoracolumbar burst fractures and neurological deficits who underwent UBE-assisted transpedicular decompression and percutaneous pedicle screw fixation between January 2021 and December 2024. Fractures were classified using the AO Spine classification system and the Thoracolumbar Injury Classification and Severity Score. Clinical outcomes included improvement in American Spinal Injury Association (ASIA) grade, visual analogue scale score, and normalized Oswestry Disability Index score. Radiological outcomes included correction of canal compromise and kyphotic angle.Results: Neurological status improved in most patients. Among the 13 neurologically symptomatic patients, 11 (84.6%) improved by at least one ASIA grade. Postoperative neurological recovery was also observed in patients who presented with complete neurological deficit (ASIA grade A, n=3), although this finding should be interpreted cautiously because of the small sample size and retrospective design. At follow-up, 4 patients (30.8%) had normal neurological function (ASIA grade E). Urinary incontinence was present preoperatively in 3 patients and resolved completely after decompression. No surgical site infection, dural tear, neurological deterioration, or instrumentation-related complication was observed.Conclusion: UBE-assisted transpedicular decompression combined with percutaneous stabilization appears to be a feasible minimally invasive option for selected patients with thoracolumbar burst fractures and neurological deficits. Careful patient selection remains essential, particularly when severe canal compromise, direct neurological compression, or posterior ligamentous complex disruption is present and direct decompression may be preferable to indirect reduction alone.
