A prospective pilot study on navigation-guided unilateral biportal endoscopic spine surgery: feasibility, workflow, and early outcomes.

BACKGROUND

Unilateral biportal endoscopy (UBE) is gaining traction as a minimally invasive technique for spinal decompression and fusion. However, limitations such as indirect visualization, poor depth perception, and lack of intraoperative orientation hinder its application in complex or multilevel cases. Intraoperative 3D navigation provides real-time anatomical accuracy, yet its integration with UBE has not been widely studied. This pilot study aims to assess the feasibility, workflow, and early outcomes of navigation-guided UBE (NAV-UBE) across spinal regions.

METHODS

This prospective single-center study included 54 patients undergoing NAV-UBE for degenerative spine conditions between October 2023 and May 2024. Navigation was employed for portal planning, decompression guidance, facet preservation, and implant placement. Patients were stratified into cervical, thoracic, lumbar, and revision groups. Clinical outcomes included VAS, ODI, time to mobilization, and hospital stay. Radiological parameters included dural expansion area, screw accuracy, cage position, and fusion status.

RESULTS

Cervical foraminotomy cases demonstrated a mean navigation-confirmed facet resection of 14.5 % with no instability. Thoracic decompression achieved a mean Nurick improvement of two grades without complications. Lumbar decompression showed significant ODI reduction (64-26), dural expansion (80 mm2), and improved claudication metrics. Lumbar fusion cases achieved 92 % Grade 1 fusion, 98.6 % screw accuracy, and no implant-related complications. Revision cases showed safe docking, fragment localization, and early mobilization (18 h).

CONCLUSIONS

NAV-UBE is a feasible and effective workflow that enhances intraoperative precision, safety, and outcomes across diverse spinal pathologies. These early results support its broader adoption in endoscopic spine surgery.