Clinical efficacy and safety of unilateral biportal endoscopy for thoracic ossification of ligamentum flavum: A systematic review.

OBJECTIVES

In this systematic review, we discuss the clinical efficacy and complications of unilateral biportal endoscopy (UBE) in the treatment of thoracic ossification of the ligamentum flavum (TOLF), providing surgeons with evidence-based guidance for optimal treatment decisions.

MATERIALS AND

METHODS

We systematically searched the PubMed, EMBASE, Cochrane Library, CNKI, Wanfang, and VIP databases up to January 2025. Inclusion criteria encompassed studies reporting UBE outcomes for single/double-segment TOLF. Data on pain (Visual Analog Scores [VAS]), function (Oswestry Disability index [ODI] and Japanese Orthopaedic Association [JOA]), and complications were pooled using random-effects models. Minimal clinically important difference (MCID) was applied as the evaluative benchmark for clinical significance.

RESULTS

Six studies (n=77) were analyzed. Significant improvements were observed in leg pain (p<0.001; 95% confidence interval [CI]: -6.63 to -3.57; I2=88%), back pain (p<0.0001; 95% CI: -6.36 to -3.83; I2=86%), ODI (p<0.00001; 95% CI: 31.00 to 53.53; I2=95%), and JOA scores (p<0.05; 95% CI: 2.80 to 3.70; I2=86%). The overall complication rate was 28% (2/6 reporting zero complications), predominantly mild (headache, hyperalgesia). Severe complications included dural tears (2.6%) and spinal cord injury (2.6%), with heterogeneity attributed to surgical technique evolution.

CONCLUSION

Preliminary evidence suggests UBE may be a promising minimally invasive approach for TOLF, potentially offering accelerated recovery and reduced perioperative morbidity. However, given the limited sample size and substantial heterogeneity, these findings require validation through large-scale prospective studies.