Evaluation of the efficacy and safety of unilateral biportal endoscopic technique for the treatment of infectious spondylitis.

OBJECTIVES

To compare the efficacy and safety of unilateral biportal endoscopic technique (UBE) and percutaneous endoscopic debridement, irrigation, and drainage for infectious spondylitis, and provide evidence for clinical decision-making.

METHODS

A retrospective study included 108 patients (February 2023-May 2024) divided into a biportal group (n=54, UBE) and single portal group (n=54, percutaneous endoscopic surgery). Surgery-related indicators, inflammatory markers (ESR (erythrocyte sedimentation rate), CRP (C-reactive protein), TNF-α (tumor necrosis factor-α)), VAS (visual analog scale), ODI (Oswestry disability index), Kirkaldy-Willis score, Cobb angle, and bacterial culture positive rate were compared. Multiple linear regression analyzed factors influencing postoperative 120-day ESR.

RESULTS

The biportal group had longer surgical duration, drainage time, and more fluoroscopy (all P<0.05). No significant differences were found in VAS, ODI, Cobb angle, Kirkaldy-Willis excellent-good rate, or bacterial culture positive rate (all P>0.05). ESR, CRP, TNF-α in biportal group were lower at 90 and 120 days postoperatively (P<0.05). UBE and preoperative ESR were independent factors for 120-day ESR (P<0.05).

CONCLUSIONS

UBE and percutaneous endoscopic surgery have comparable efficacy in relieving pain, improving function, correcting deformity, and pathogen detection. UBE provides better long-term inflammatory control, and surgical choice should consider disease complexity, surgeon proficiency, and need for inflammatory control.