Short term complications and risk factors of unilateral biportal endoscopic cervical spine surgery in patients with cervical radiculopathy and myelopathy: a single center retrospective study.

OBJECTIVE

To describe the incidence, types, severity, and risk factors of short-term complications following unilateral biportal endoscopic (UBE) cervical spine surgery in patients with cervical radiculopathy (CR) and cervical myelopathy (CM).

METHODS

We retrospectively analyzed 107 consecutive patients who underwent UBE cervical spine surgery at a single center between June 2021 and June 2024 (CR: n = 68; CM: n = 39). Demographic, clinical, and surgical data were collected. Complications were systematically documented and classified using the Clavien-Dindo system. Firth's penalized logistic regression was used to identify risk factors for complications.

RESULTS

The overall complication rate was 12.1% (13/107). Complications occurred in 7.4% (5/68) of patients with CR and 20.5% (8/39) of patients with CM. In the CR group, all complications were minor (Clavien-Dindo Grade I) and resolved with conservative management. In the CM group, complications were more severe, including symptomatic epidural hematoma requiring surgical evacuation (10.3%). Independent risk factors identified by Firth's penalized logistic regression included age ≥65 years (OR = 3.38, 95% CI 1.39-8.22, p = 0.007), comorbidities (OR = 2.70, 95% CI 1.19-6.13, p = 0.017), and laminectomy (versus foraminotomy) (OR = 3.15, 95% CI 1.36-7.30, p = 0.008). The learning curve analysis showed a significantly higher complication rate in the first 20 cases (8/20, 40.0%) compared with subsequent cases (5/87, 5.7%, p = 0.0002). Both groups achieved significant functional improvements at final follow-up.

CONCLUSION

UBE cervical spine surgery demonstrates an acceptable safety profile in patients with cervical radiculopathy. However, patients with cervical myelopathy, particularly those undergoing multi-segment laminectomy and flavectomy, carry higher complication risks. Careful patient selection, surgical planning, and attention to the learning curve are essential to optimize outcomes.