Learning Curve and Complications of Unilateral Biportal Endoscopy: Cumulative Sum and Risk-Adjusted Cumulative Sum Analysis

Abstract

Objective：The purpose of this study was to investigate the learning curve and complications of unilateral biportal endoscopy (UBE) in the treatment of lumbar disc herniation (LDH) and lumbar spinal stenosis (LSS).Methods: This was a retrospective cohort analysis of 197 consecutive patients who received UBE unilateral laminotomy bilateral decompression (UBE-ULBD) or lumbar discectomy (UBE-LD) surgery, including 107 males and 90 females with an average age of 64.83 ± 14.29 years. Cumulative sum (CUSUM) and risk-adjusted cumulative sum analysis (RA-CUSUM) were used to evaluate the learning curve, with the occurrence of complications defined as surgical failure, and variables of different phase of the learning curve were compared. Results:The cutoff point of learning curve of UBE surgery was 54 cases according to CUSUM analysis.The learning curve of UBE-ULBD and UBE-LD were divided into three phases. The first cutoff points were 31 and 12 cases, and the second cutoff point were 67 and 32 cases respectively. With the progress of the learning curve, the operation time and postoperative hospital stays decreased. The VAS and ODI at the last follow-up were significantly lower than that before surgery. The incidence of surgical failure was 6.11% and began to decrease after the 89 th case based on RA-CUSUM analysis. The surgical failure rate decreased from 10.11% to 2.78 after the 89 th case with significant different. Conclusion:UBE surgery is effective in the treatment of LDH and LSS with low incidence of complications. But a learning curve of at least 54 cases still required for mastering UBE surgery.

Clinical comparison of percutaneous transforaminal endoscopic discectomy and unilateral biportal endoscopic discectomy for single-level lumbar disc herniation

“…Therefore, the learning curve of UBE is relatively flat and short. Xu demonstrated that the learning curve for mastering UBE is 54 cases ( 29 ).…”

Unilateral biportal endoscopic lumbar interbody fusion enhanced the recovery of patients with the lumbar degenerative disease compared with the conventional posterior procedures: A systematic review and meta-analysis

“…Although the surgical complication rate was similar between ULIF and conventional procedures (ULIF vs. MI-TLIF, 6.9 vs. 6.7%; ULIF vs. PLIF, 6.8% vs. 5.1%), the slightly higher incidence of dural tear in the ULIF group should be noted (ULIF vs. MI-TLIF, 4.8% vs. 2.1%; ULIF vs. PLIF, 4.7% vs. 2.8%). Therefore, ULIF is recommended for surgeons who have performed at least 54 cases of biportal endoscopic decompression ( 70 ). Another complication was the epidural hematoma, most likely due to oozing from the bone trapped under the intact posterior tension band, which usually could be resolved by itself ( 32 ).…”

Efficacy and safety of unilateral biportal endoscopic discectomy and conventional endoscopic discectomy in the treatment of lumbar disc herniation: a systematic review and meta-analysis

“…Ultimately, 7 articles were included in the meta-analysis, with a total sample size of 760 cases, including 398 cases in the UBE group and 362 cases in the control group. The basic characteristics of the included literature are shown in Table 1 (14)(15)(16)(17)(18)(19)(20).…”