Abstract
ABSTRACT
Background
Uniportal non‐coaxial spinal endoscopic surgery (UNSES) via far‐lateral approach (FLA) is an innovative minimally invasive procedure for lumbar degenerative diseases, particularly far‐lateral disc herniation and foraminal stenosis. However, complex lateral lumbar anatomy and strict endoscope‐instrument coordination create a distinct learning curve that may compromise early surgical efficiency and safety. This study aimed to evaluate the efficacy and safety, quantify the learning curve, and to provide clinical guidance for the standardized promotion and application of this technology.
Methods
A total of 40 consecutive patients with lumbar degenerative diseases who underwent UNSES via FLA by a single surgeon between January 2025 and December 2025 were included. All data were analyzed using SPSS 26.0 statistical software (IBM, USA). Primary outcomes included operation time, blood loss, fluoroscopy frequency, and intraoperative complication rate. Secondary outcomes were VAS, ODI, and modified Macnab criteria at 1, 3, and 6 months postoperatively. The learning curve and the inflection point of the learning curve was determined using cumulative sum (CUSUM) analysis. The differences in clinical indicators between early and proficient stage were compared.
Result
Operation time, blood loss, and fluoroscopy times decreased significantly with case accumulation (
p
p
p
p
> 0.05). The total complication rate was 12.5% (5/40), were cured by conservative treatment. The total excellent‐good rate was 90.0% (36/40). L5/S1 and Bertolotti's syndrome were independent factors affecting the learning curve.
Conclusion
UNSES via FLA is a safe and effective minimally invasive technique for treating complex lumbar degenerative diseases. It has a certain learning curve, and the inflection point is about the 16th case. After mastering the key techniques such as anatomical positioning, endoscopic manipulation and hemostasis, the surgeon can gradually reach the proficiency stage, with significantly improved surgical efficiency and clinical efficacy, and controllable complications. This study provides a theoretical basis for the clinical training and technology promotion of UNSES via FLA.