Research progress of unilateral biportal endoscopy technology in cervical degenerative disease_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

TANG Runmin ¹ , TAN Lixian ¹ , LAI Guoqiang ² , RONG Limin ¹ ,  ZHANG Liangming ¹

1. Department of Spine Surgery, the Third Affiliated Hospital, Sun Yat-sen University, Guangzhou Guangdong, 510630, P. R. China;
2. Department of Trauma and Joint Surgery, the Third Affiliated Hospital, Sun Yat-sen University, Guangzhou Guangdong, 510630, P. R. China;

Corresponding author：

ZHANG Liangming, Email: zhanglm36@mail.sysu.edu.cn

Keywords：

Unilateral biportal endoscopy; cervical spondylotic radiculopathy; cervical spondylotic myelopathy

DOI：

10.7507/1002-1892.202412037

Video：

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Abstract Full text Figures/Tables Video References Cited by

Objective To review the application and progress of unilateral biportal endoscopy (UBE) technology in the treatment of cervical degenerative diseases, and to provide reference for clinical treatment decisions. Methods The literatures related to UBE in the treatment of cervical spondylotic radiculopathy (CSR) and cervical spondylotic myelopathy (CSM) at home and abroad were extensively reviewed, and the surgical methods, indications, effectiveness, and safety were analyzed and summarized. Results UBE technology is effective in the treatment of CSR and CSM, and has the advantages of good surgical field, reducing the injury of the posterior structure of the cervical spine, and protecting the facet joint process, but in general, the indications are relatively narrow, limited to single-segment or adjacent double-segment lesions, and the requirements for the operator are relatively high, and the learning curve is long. Conclusion UBE technology can be applied to the treatment of CSR and CSM, but it needs to be carried out by experienced UBE surgeons for specific cases.

1.	田大胜, 朱斌, 荆珏华. 单侧双通道内镜技术在脊柱外科的应用拓展与相关问题. 中华医学杂志, 2022, 102(41): 3241-3245.
2.	张玉红, 田霖, 胡鹏, 等. 单侧双通道脊柱内镜技术治疗腰椎相关疾病的研究进展. 中国修复重建外科杂志, 2022, 36(10): 1234-1240.
3.	中华外科杂志编辑部. 颈椎病的分型、诊断及非手术治疗专家共识 (2018). 中华外科杂志, 2018, 56(6): 401-402.
4.	Theodore N. Degenerative cervical spondylosis. N Engl J Med, 2020, 383(2): 159-168.
5.	Woods BI, Hilibrand AS. Cervical radiculopathy: epidemiology, etiology, diagnosis, and treatment. J Spinal Disord Tech, 2015, 28(5): E251-E259.
6.	Maharaj MM, Mobbs RJ, Hogan J, et al. Anterior cervical disc arthroplasty (ACDA) versus anterior cervical discectomy and fusion (ACDF): a systematic review and meta-analysis. J Spine Surg, 2015, 1(1): 72-85.
7.	Epstein NE. A review of complication rates for anterior cervical diskectomy and fusion (ACDF). Surg Neurol Int, 2019, 10: 100. doi: 10.25259/SNI-191-2019.
8.	Song KS, Lee CW. The biportal endoscopic posterior cervical inclinatory foraminotomy for cervical radiculopathy: Technical report and preliminary results. Neurospine, 2020, 17(Suppl 1): S145-S153.
9.	Chen BH, Natarajan RN, An HS, et al. Comparison of biomechanical response to surgical procedures used for cervical radiculopathy: posterior keyhole foraminotomy versus anterior foraminotomy and discectomy versus anterior discectomy with fusion. J Spinal Disord, 2001, 14(1): 17-20.
10.	Peng W, Chu R, Cui W, et al. Unilateral biportal endoscopic decompression versus anterior cervical decompression and fusion for unilateral cervical radiculopathy or coexisting cervical myelopathy: a prospective, randomized, controlled, noninferiority trial. BMC Musculoskelet Disord, 2024, 25(1): 582. doi: 10.1186/s12891-024-07697-3.
11.	Park JH, Jun SG, Jung JT, et al. Posterior percutaneous endoscopic cervical foraminotomy and diskectomy with unilateral biportal endoscopy. Orthopedics, 2017, 40(5): e779-e783.
12.	Kim JE, Choi DJ. Unilateral biportal endoscopic decompression by 30° endoscopy in lumbar spinal stenosis: Technical note and preliminary report. J Orthop, 2018, 15(2): 366-371.
13.	Jung SB, Kim N. Biportal endoscopic spine surgery for cervical disk herniation: A technical notes and preliminary report. Medicine (Baltimore), 2022, 101(27): e29751. doi: 10.1097/MD.0000000000029751.
14.	林振, 彭柏华, 郑力恒, 等. 单侧双通道内镜技术治疗神经根型颈椎病的早期临床疗效. 中国脊柱脊髓杂志, 2022, 32(7): 668-672.
15.	Wen M, Li X, Lu X, et al. Short-term efficacy of unilateral biportal endoscopy technology in the treatment of cervical spondylotic radiculopathy. Eur Spine J, 2025, 34(1): 118-127.
16.	Jung SB, Gunadala I, Kim N. Comparison of cervical biportal endoscopic spine surgery and anterior cervical discectomy and fusion in patients with symptomatic cervical disc herniation. J Clin Med, 2024, 13(6): 1823. doi: 10.3390/jcm13061823.
17.	Kang MS, You KH, Han SY, et al. Percutaneous full-endoscopic versus biportal endoscopic posterior cervical foraminotomy for unilateral cervical foraminal disc disease. Clin Orthop Surg, 2022, 14(4): 539-547.
18.	Zhong Z, Hu Q, Huang L, et al. Unilateral biportal endoscopic posterior cervical foraminotomy: An outcome comparison with the full-endoscopic posterior cervical foraminotomy. Clin Spine Surg, 2024, 37(1): 23-30.
19.	Wang D, Xu J, Zhu C, et al. Comparison of outcomes between unilateral biportal endoscopic and percutaneous posterior endoscopic cervical keyhole surgeries. Medicina (Kaunas), 2023, 59(3): 437. doi: 10.3390/medicina59030437.
20.	Kim JY, Hong HJ, Lee DC, et al. Comparative analysis of 3 types of minimally invasive posterior cervical foraminotomy for foraminal atenosis, uniportal-, biportal endoscopy, and microsurgery: Radiologic and midterm clinical outcomes. Neurospine, 2022, 19(1): 212-223.
21.	Zdeblick TA, Zou D, Warden KE, et al. Cervical stability after foraminotomy. A biomechanical in vitro analysis. J Bone Joint Surg (Am), 1992, 74(1): 22-27.
22.	晏美俊, 郭松, 付强, 等. 三种内镜手术技术治疗神经根型颈椎病的临床疗效比较. 中国脊柱脊髓杂志, 2023, 33(7): 610-618.
23.	Zhang P, Jin Y, Zhu B, et al. Unilateral biportal endoscopic foraminotomy and diskectomy combined with piezosurgery for treating cervical spondylotic radiculopathy with neuropathic radicular pain. Front Neurol, 2023, 14: 1100641. doi: 10.3389/fneur.2023.1100641.
24.	Song KS, Kim P. Assessment of clinical and radiologic outcomes of biportal endoscopic posterior cervical inclinatory foraminotomy: A retrospective cohort study. J Korean Neurosurg Soc, 2025. doi: 10.3340/jkns.2024.0197.
25.	Xi Z, Lu Y, Xie L. Endoscopic posterior cervical foraminotomy via a single stab incision for contiguous two-level cervical radiculopathy. Acta Neurochir (Wien), 2020, 162(3): 685-689.
26.	Heo DH, Ha JS, Jang JW. Biportal endoscopic posterior cervical foraminotomy for adjacent 2-level foraminal lesions using a single approach (sliding technique). Neurospine, 2023, 20(1): 92-98.
27.	Son S, Ahn Y, Lee SG, et al. Learning curve of percutaneous endoscopic transforaminal lumbar discectomy by a single surgeon. Medicine (Baltimore), 2021, 100(4): e24346. doi: 10.1097/MD.0000000000024346.
28.	Kang MS, Park HJ, Park SM, et al. Learning curve for biportal endoscopic posterior cervical foraminotomy determined using the cumulative summation test. J Orthop Surg Res, 2023, 18(1): 146. doi: 10.1186/s13018-023-03611-0.
29.	Donnally CJ, Patel PD, Canseco JA, et al. Current management of cervical spondylotic myelopathy. Clin Spine Surg, 2022, 35(1): E68-E76.
30.	刘立俊, 高山, 马广斌, 等. 脊髓型颈椎病发病机制及治疗措施的研究进展. 中国临床研究, 2024, 37(5): 661-665.
31.	Minamide A, Yoshida M, Yamada H, et al. Clinical outcomes of microendoscopic decompression surgery for cervical myelopathy. Eur Spine J, 2010, 19(3): 487-493.
32.	Carr DA, Abecassis IJ, Hofstetter CP. Full endoscopic unilateral laminotomy for bilateral decompression of the cervical spine: surgical technique and early experience. J Spine Surg, 2020, 6(2): 447-456.
33.	Zhu C, Zhou X, Ge G, et al. Unilateral biportal endoscopic laminectomy for treating cervical stenosis: A technical note and preliminary results. Medicina (Kaunas), 2023, 59(2): 305. doi: 10.3390/medicina59020305.
34.	Kim J, Heo DH, Lee DC, et al. Biportal endoscopic unilateral laminotomy with bilateral decompression for the treatment of cervical spondylotic myelopathy. Acta Neurochir (Wien), 2021, 163(9): 2537-2543.
35.	Zhu C, Deng X, Pan H, et al. Unilateral biportal endoscopic laminectomy with lateral mass screw fixation for treating cervical spinal stenosis. Acta Neurochir (Wien), 2022, 164(6): 1529-1533.
36.	Zhu C, Cheng W, Wang D, et al. A helpful third portal for unilateral biportal endoscopic decompression in patients with cervical spondylotic myelopathy: A technical note. World Neurosurg, 2022, 161: 75-81.
37.	刘洋, 唐骞, 王宇鹏, 等. 单侧双通道内镜下颈椎后路全椎板切除减压术对颈椎管狭窄症的早期疗效及安全性. 中华医学杂志, 2024, 104(29): 2779-2782.
38.	Cho SK, Kim JS, Overley SC, et al. Cervical laminoplasty: Indications, surgical considerations, and clinical outcomes. J Am Acad Orthop Surg, 2018, 26(7): e142-e152.
39.	Zhu C, Wang J, Cheng W, et al. Case report: Bilateral biportal endoscopic open-door laminoplasty with the use of suture anchors: A technical report and literature review. Front Surg, 2022, 9: 913456. doi: 10.3389/fsurg.2022.913456.
40.	Kim JY, Heo DH. Biportal endoscopic cervical open-door laminoplasty to treat cervical spondylotic myelopathy. Acta Neurochir (Wien), 2024, 166(1): 182. doi: 10.1007/s00701-024-06076-0.
41.	Li Z, Zhou W, Liang J, et al. Clinical efficacy and complications of spinal surgery unilateral biportal endoscopy for cervical spondylosis: A systematic review and meta-analysis. World Neurosurg, 2025, 194: 123386. doi: 10.1016/j.wneu.2024.10.115.
42.	Wu PF, Li YW, Wang B, et al. Posterior cervical foraminotomy via full-endoscopic versus microendoscopic approach for radiculopathy: A systematic review and meta-analysis. Pain Physician, 2019, 22(1): 41-52.
43.	Ju CI, Kim P, Seo JH, et al. Complications of cervical endoscopic spinal surgery: A systematic review and narrative analysis. World Neurosurg, 2023, 178: 330-339.
44.	Lee HG, Kang MS, Kim SY, et al. Dural injury in unilateral biportal endoscopic spinal surgery. Global Spine J, 2021, 11(6): 845-851.
45.	Park HJ, Kim SK, Lee SC, et al. Dural tears in percutaneous biportal endoscopic spine surgery: Anatomical location and management. World Neurosurg, 2020, 136: e578-e585.
46.	Choi DJ, Kim JE. Efficacy of biportal endoscopic spine surgery for lumbar spinal stenosis. Clin Orthop Surg, 2019, 11(1): 82-88.
47.	Boadi BI, Ikwuegbuenyi CA, Inzerillo S, et al. Complications in minimally invasive spine surgery in the last 10 years: A narrative review. Neurospine, 2024, 21(3): 770-803.
48.	Kim HS, Raorane HD, Wu PH, et al. Incidental durotomy during endoscopic stenosis lumbar decompression: Incidence, classification, and proposed management strategies. World Neurosurg, 2020, 139: e13-e22.
49.	Kim JE, Choi DJ, Kim MC, et al. Risk factors of postoperative spinal epidural hematoma after biportal endoscopic spinal surgery. World Neurosurg, 2019, 129: e324-e329.
50.	Kim JE, Yoo HS, Choi DJ, et al. Effectiveness of gelatin-thrombin matrix sealants (Floseal^®) on postoperative spinal epidural hematoma during single-level lumbar decompression using biportal endoscopic spine surgery: Clinical and magnetic resonance image study. Biomed Res Int, 2020, 2020: 4801641. doi: 10.1155/2020/4801641.
51.	Amiri AR, Fouyas IP, Cro S, et al. Postoperative spinal epidural hematoma (SEH): incidence, risk factors, onset, and management. Spine J, 2013, 13(2): 134-140.
52.	Ahn DK, Lee JS, Shin WS, et al. Postoperative spinal epidural hematoma in a biportal endoscopic spine surgery. Medicine (Baltimore), 2021, 100(6): e24685. doi: 10.1097/MD.0000000000024685.
53.	Liang J, Lian L, Liang S, et al. Efficacy and complications of unilateral biportal endoscopic spinal surgery for lumbar spinal stenosis: A meta-analysis and systematic review. World Neurosurg, 2022, 159: e91-e102.

1. 田大胜, 朱斌, 荆珏华. 单侧双通道内镜技术在脊柱外科的应用拓展与相关问题. 中华医学杂志, 2022, 102(41): 3241-3245.
2. 张玉红, 田霖, 胡鹏, 等. 单侧双通道脊柱内镜技术治疗腰椎相关疾病的研究进展. 中国修复重建外科杂志, 2022, 36(10): 1234-1240.
3. 中华外科杂志编辑部. 颈椎病的分型、诊断及非手术治疗专家共识 (2018). 中华外科杂志, 2018, 56(6): 401-402.
4. Theodore N. Degenerative cervical spondylosis. N Engl J Med, 2020, 383(2): 159-168.
5. Woods BI, Hilibrand AS. Cervical radiculopathy: epidemiology, etiology, diagnosis, and treatment. J Spinal Disord Tech, 2015, 28(5): E251-E259.
6. Maharaj MM, Mobbs RJ, Hogan J, et al. Anterior cervical disc arthroplasty (ACDA) versus anterior cervical discectomy and fusion (ACDF): a systematic review and meta-analysis. J Spine Surg, 2015, 1(1): 72-85.
7. Epstein NE. A review of complication rates for anterior cervical diskectomy and fusion (ACDF). Surg Neurol Int, 2019, 10: 100. doi: 10.25259/SNI-191-2019.
8. Song KS, Lee CW. The biportal endoscopic posterior cervical inclinatory foraminotomy for cervical radiculopathy: Technical report and preliminary results. Neurospine, 2020, 17(Suppl 1): S145-S153.
9. Chen BH, Natarajan RN, An HS, et al. Comparison of biomechanical response to surgical procedures used for cervical radiculopathy: posterior keyhole foraminotomy versus anterior foraminotomy and discectomy versus anterior discectomy with fusion. J Spinal Disord, 2001, 14(1): 17-20.
10. Peng W, Chu R, Cui W, et al. Unilateral biportal endoscopic decompression versus anterior cervical decompression and fusion for unilateral cervical radiculopathy or coexisting cervical myelopathy: a prospective, randomized, controlled, noninferiority trial. BMC Musculoskelet Disord, 2024, 25(1): 582. doi: 10.1186/s12891-024-07697-3.
11. Park JH, Jun SG, Jung JT, et al. Posterior percutaneous endoscopic cervical foraminotomy and diskectomy with unilateral biportal endoscopy. Orthopedics, 2017, 40(5): e779-e783.
12. Kim JE, Choi DJ. Unilateral biportal endoscopic decompression by 30° endoscopy in lumbar spinal stenosis: Technical note and preliminary report. J Orthop, 2018, 15(2): 366-371.
13. Jung SB, Kim N. Biportal endoscopic spine surgery for cervical disk herniation: A technical notes and preliminary report. Medicine (Baltimore), 2022, 101(27): e29751. doi: 10.1097/MD.0000000000029751.
14. 林振, 彭柏华, 郑力恒, 等. 单侧双通道内镜技术治疗神经根型颈椎病的早期临床疗效. 中国脊柱脊髓杂志, 2022, 32(7): 668-672.
15. Wen M, Li X, Lu X, et al. Short-term efficacy of unilateral biportal endoscopy technology in the treatment of cervical spondylotic radiculopathy. Eur Spine J, 2025, 34(1): 118-127.
16. Jung SB, Gunadala I, Kim N. Comparison of cervical biportal endoscopic spine surgery and anterior cervical discectomy and fusion in patients with symptomatic cervical disc herniation. J Clin Med, 2024, 13(6): 1823. doi: 10.3390/jcm13061823.
17. Kang MS, You KH, Han SY, et al. Percutaneous full-endoscopic versus biportal endoscopic posterior cervical foraminotomy for unilateral cervical foraminal disc disease. Clin Orthop Surg, 2022, 14(4): 539-547.
18. Zhong Z, Hu Q, Huang L, et al. Unilateral biportal endoscopic posterior cervical foraminotomy: An outcome comparison with the full-endoscopic posterior cervical foraminotomy. Clin Spine Surg, 2024, 37(1): 23-30.
19. Wang D, Xu J, Zhu C, et al. Comparison of outcomes between unilateral biportal endoscopic and percutaneous posterior endoscopic cervical keyhole surgeries. Medicina (Kaunas), 2023, 59(3): 437. doi: 10.3390/medicina59030437.
20. Kim JY, Hong HJ, Lee DC, et al. Comparative analysis of 3 types of minimally invasive posterior cervical foraminotomy for foraminal atenosis, uniportal-, biportal endoscopy, and microsurgery: Radiologic and midterm clinical outcomes. Neurospine, 2022, 19(1): 212-223.
21. Zdeblick TA, Zou D, Warden KE, et al. Cervical stability after foraminotomy. A biomechanical in vitro analysis. J Bone Joint Surg (Am), 1992, 74(1): 22-27.
22. 晏美俊, 郭松, 付强, 等. 三种内镜手术技术治疗神经根型颈椎病的临床疗效比较. 中国脊柱脊髓杂志, 2023, 33(7): 610-618.
23. Zhang P, Jin Y, Zhu B, et al. Unilateral biportal endoscopic foraminotomy and diskectomy combined with piezosurgery for treating cervical spondylotic radiculopathy with neuropathic radicular pain. Front Neurol, 2023, 14: 1100641. doi: 10.3389/fneur.2023.1100641.
24. Song KS, Kim P. Assessment of clinical and radiologic outcomes of biportal endoscopic posterior cervical inclinatory foraminotomy: A retrospective cohort study. J Korean Neurosurg Soc, 2025. doi: 10.3340/jkns.2024.0197.
25. Xi Z, Lu Y, Xie L. Endoscopic posterior cervical foraminotomy via a single stab incision for contiguous two-level cervical radiculopathy. Acta Neurochir (Wien), 2020, 162(3): 685-689.
26. Heo DH, Ha JS, Jang JW. Biportal endoscopic posterior cervical foraminotomy for adjacent 2-level foraminal lesions using a single approach (sliding technique). Neurospine, 2023, 20(1): 92-98.
27. Son S, Ahn Y, Lee SG, et al. Learning curve of percutaneous endoscopic transforaminal lumbar discectomy by a single surgeon. Medicine (Baltimore), 2021, 100(4): e24346. doi: 10.1097/MD.0000000000024346.
28. Kang MS, Park HJ, Park SM, et al. Learning curve for biportal endoscopic posterior cervical foraminotomy determined using the cumulative summation test. J Orthop Surg Res, 2023, 18(1): 146. doi: 10.1186/s13018-023-03611-0.
29. Donnally CJ, Patel PD, Canseco JA, et al. Current management of cervical spondylotic myelopathy. Clin Spine Surg, 2022, 35(1): E68-E76.
30. 刘立俊, 高山, 马广斌, 等. 脊髓型颈椎病发病机制及治疗措施的研究进展. 中国临床研究, 2024, 37(5): 661-665.
31. Minamide A, Yoshida M, Yamada H, et al. Clinical outcomes of microendoscopic decompression surgery for cervical myelopathy. Eur Spine J, 2010, 19(3): 487-493.
32. Carr DA, Abecassis IJ, Hofstetter CP. Full endoscopic unilateral laminotomy for bilateral decompression of the cervical spine: surgical technique and early experience. J Spine Surg, 2020, 6(2): 447-456.
33. Zhu C, Zhou X, Ge G, et al. Unilateral biportal endoscopic laminectomy for treating cervical stenosis: A technical note and preliminary results. Medicina (Kaunas), 2023, 59(2): 305. doi: 10.3390/medicina59020305.
34. Kim J, Heo DH, Lee DC, et al. Biportal endoscopic unilateral laminotomy with bilateral decompression for the treatment of cervical spondylotic myelopathy. Acta Neurochir (Wien), 2021, 163(9): 2537-2543.
35. Zhu C, Deng X, Pan H, et al. Unilateral biportal endoscopic laminectomy with lateral mass screw fixation for treating cervical spinal stenosis. Acta Neurochir (Wien), 2022, 164(6): 1529-1533.
36. Zhu C, Cheng W, Wang D, et al. A helpful third portal for unilateral biportal endoscopic decompression in patients with cervical spondylotic myelopathy: A technical note. World Neurosurg, 2022, 161: 75-81.
37. 刘洋, 唐骞, 王宇鹏, 等. 单侧双通道内镜下颈椎后路全椎板切除减压术对颈椎管狭窄症的早期疗效及安全性. 中华医学杂志, 2024, 104(29): 2779-2782.
38. Cho SK, Kim JS, Overley SC, et al. Cervical laminoplasty: Indications, surgical considerations, and clinical outcomes. J Am Acad Orthop Surg, 2018, 26(7): e142-e152.
39. Zhu C, Wang J, Cheng W, et al. Case report: Bilateral biportal endoscopic open-door laminoplasty with the use of suture anchors: A technical report and literature review. Front Surg, 2022, 9: 913456. doi: 10.3389/fsurg.2022.913456.
40. Kim JY, Heo DH. Biportal endoscopic cervical open-door laminoplasty to treat cervical spondylotic myelopathy. Acta Neurochir (Wien), 2024, 166(1): 182. doi: 10.1007/s00701-024-06076-0.
41. Li Z, Zhou W, Liang J, et al. Clinical efficacy and complications of spinal surgery unilateral biportal endoscopy for cervical spondylosis: A systematic review and meta-analysis. World Neurosurg, 2025, 194: 123386. doi: 10.1016/j.wneu.2024.10.115.
42. Wu PF, Li YW, Wang B, et al. Posterior cervical foraminotomy via full-endoscopic versus microendoscopic approach for radiculopathy: A systematic review and meta-analysis. Pain Physician, 2019, 22(1): 41-52.
43. Ju CI, Kim P, Seo JH, et al. Complications of cervical endoscopic spinal surgery: A systematic review and narrative analysis. World Neurosurg, 2023, 178: 330-339.
44. Lee HG, Kang MS, Kim SY, et al. Dural injury in unilateral biportal endoscopic spinal surgery. Global Spine J, 2021, 11(6): 845-851.
45. Park HJ, Kim SK, Lee SC, et al. Dural tears in percutaneous biportal endoscopic spine surgery: Anatomical location and management. World Neurosurg, 2020, 136: e578-e585.
46. Choi DJ, Kim JE. Efficacy of biportal endoscopic spine surgery for lumbar spinal stenosis. Clin Orthop Surg, 2019, 11(1): 82-88.
47. Boadi BI, Ikwuegbuenyi CA, Inzerillo S, et al. Complications in minimally invasive spine surgery in the last 10 years: A narrative review. Neurospine, 2024, 21(3): 770-803.
48. Kim HS, Raorane HD, Wu PH, et al. Incidental durotomy during endoscopic stenosis lumbar decompression: Incidence, classification, and proposed management strategies. World Neurosurg, 2020, 139: e13-e22.
49. Kim JE, Choi DJ, Kim MC, et al. Risk factors of postoperative spinal epidural hematoma after biportal endoscopic spinal surgery. World Neurosurg, 2019, 129: e324-e329.
50. Kim JE, Yoo HS, Choi DJ, et al. Effectiveness of gelatin-thrombin matrix sealants (Floseal^®) on postoperative spinal epidural hematoma during single-level lumbar decompression using biportal endoscopic spine surgery: Clinical and magnetic resonance image study. Biomed Res Int, 2020, 2020: 4801641. doi: 10.1155/2020/4801641.
51. Amiri AR, Fouyas IP, Cro S, et al. Postoperative spinal epidural hematoma (SEH): incidence, risk factors, onset, and management. Spine J, 2013, 13(2): 134-140.
52. Ahn DK, Lee JS, Shin WS, et al. Postoperative spinal epidural hematoma in a biportal endoscopic spine surgery. Medicine (Baltimore), 2021, 100(6): e24685. doi: 10.1097/MD.0000000000024685.
53. Liang J, Lian L, Liang S, et al. Efficacy and complications of unilateral biportal endoscopic spinal surgery for lumbar spinal stenosis: A meta-analysis and systematic review. World Neurosurg, 2022, 159: e91-e102.

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