Clinical Efficacy of the Uniportal Bichannel Dual-Media Spinal Endoscopic Technique in Older Patients With Lumbar Disc Herniation and Instability

Muhang Tian; Furui Liu; Yunshan Fan; Tinghuan Hu; Yingchuan Zhao; Sergey Mlyavyk; Shisheng He

doi:10.21182/jmisst.2025.02985

J Minim Invasive Spine Surg Tech > Volume 11(1); 2026 > Article

Tian, Liu, Fan, Hu, Zhao, Mlyavyk, and He: Clinical Efficacy of the Uniportal Bichannel Dual-Media Spinal Endoscopic Technique in Older Patients With Lumbar Disc Herniation and Instability

Original Article

Journal of Minimally Invasive Spine Surgery and Technique 2026; 11(1): 77-84.

Published online: April 30, 2026

DOI: https://doi.org/10.21182/jmisst.2025.02985

Clinical Efficacy of the Uniportal Bichannel Dual-Media Spinal Endoscopic Technique in Older Patients With Lumbar Disc Herniation and Instability

Muhang Tian^1,^2,^*

, Furui Liu^3,^*

, Yunshan Fan^1,²

, Tinghuan Hu³

, Yingchuan Zhao¹, Sergey Mlyavyk⁴, Shisheng He¹

¹Department of Orthopedic, Shanghai East Hospital, Tongji University, Shanghai, China

²2Department of Orthopedic, Shanghai Tenth People Hospital, Tongji University, Shanghai, China

³Department of Orthopedic, Kunming Guandu District People's Hospital, Kunming, China

⁴Spine Surgery and Pain Management Department, JSC Ilyinskaya Hospital, Moscow and Moscow Oblast, Russia

Corresponding Author: Sergey Mlyavykh Spine Surgery and Pain Management Department, JSC Ilyinskaya Hospital, Moscow and Moscow Oblast, Russia Email: serg.mlyavykh@fmail.com

Co-corresponding Author: Shisheng He Department of Orthopedic, Shanghai East Hospital, Tongji University, 150# Jimo Road, Shanghai, China Email: tjhss7418@tongji.edu.cn

^*Muhang Tian and Furui Liu contributed equally to this study as co-first authors.

Received November 22, 2025 Revised February 7, 2026 Accepted February 9, 2026

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (https://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Objective

To compare the effectiveness of the uniportal bichannel dual-media spinal endoscopic technique (UBD-TLIF) with open transforaminal lumbar interbody fusion (O-TLIF) for the treatment of lumbar disc herniation (LDH) with lumbar instability in older patients aged ≥65 years.

Methods

This retrospective study included 64 older patients with LDH and lumbar instability who were admitted to Shanghai Tenth People Hospital between January 2023 and June 2025. General surgical parameters, perioperative pain levels, pre- and postoperative back and leg pain scores, functional outcomes, complication status, and lumbar spine stability were recorded and analyzed.

Results

In the UBD-TLIF group, intraoperative blood loss was significantly lower than in the O-TLIF group. The UBD-TLIF group also demonstrated shorter incision length, reduced bed rest duration, and a shorter hospital stay compared with the O-TLIF group (p<0.05). Postoperatively, patients in the UBD-TLIF group showed significant improvement in visual analogue scale and Oswestry Disability Index scores (p<0.001). No complications were observed in either group.

Conclusion

Both UBD-TLIF and O-TLIF improved lumbar function in older patients with LDH and lumbar instability and demonstrated acceptable safety profiles. Compared with O-TLIF, UBD-TLIF, characterized by a smaller incision, was associated with reduced intraoperative blood loss, decreased early postoperative pain, and accelerated early recovery.

Key Words: Intervertebral disc displacement, Lumbar vertebrae, Joint instability, Endoscopy, spinal

INTRODUCTION

Lumbar disc herniation (LDH) has seen a gradual increase in incidence in recent years, becoming a common degenerative condition affecting middle-aged and elderly individuals in spinal surgery [1,2]. LDH is often associated with lumbar instability and frequently leads to neurogenic lower back and leg pain, limb numbness, and claudication in patients, adversely affecting their quality of life [3]. Clinically, LDH is generally managed with conservative treatment. However, surgical intervention is recommended for patients where conservative management proves ineffective or where the condition is more severe [4]. Due to the limited natural spaces within the spine, traditional open surgery necessitates extensive dissection of the posterior structures surrounding the intervertebral disc, thereby increasing the risk of injury to the spinal canal nerves and cauda equina, which often lead to postoperative chronic low back pain and iatrogenic instability [5,6].

Currently, with the number of elderly people rapidly increasing, LDH has a significant impact on health and disability [7]. For elderly patients suffering from this condition, extensive soft tissue damage and bleeding are difficult to tolerate, leading to prolonged healing times, impaired functional recovery, and persistent pain. Consequently, less invasive surgical approaches are required [8]. A widely used surgical technique is the open transforaminal lumbar interbody fusion (O-TLIF), which enables the removal of proliferative tissue, with intraoperative bone grafting stabilising the lumbar spine [9]. However, this procedure induces functional deactivation of the affected segment postoperatively, thereby accelerating the degenerative process of the spine [10,11].

Endoscopic surgery, as a branch of minimally invasive surgery, has developed rapidly in recent years and has the advantages of minimal muscle and bone damage [12]. Our previous studies introduced a uniportal bichannel dual-media (UBD) spinal endoscope system, also known as the V-shape bichannel endoscopy, as an innovative approach to spinal surgery [3,12-15]. Both channels of the UBD system can be used as working channels and are compatible with both air and water media. This allows the surgeon to perform precise surgery and stop bleeding in a clear, magnified view, minimizing soft tissue damage and making the surgery more efficient. Herein, we conducted this retrospective study to compare the clinical outcomes of uniportal bichannel dual-media spinal endoscopic technique (UBD-TLIF) versus conventional O-TLIF in elderly patients with LDH and lumbar instability.

MATERIALS AND METHODS

1. Study Population

This study was approved by the Institutional Ethical Committee of Shanghai Tenth People Hospital (IRB No. 20KT144). Informed consent was obtained from all individual participants included in the study. A retrospective analysis was conducted on 64 patients with LDH and lumbar instability admitted to our hospital between January 2023 to June 2025. Patients were treated by 2 independent surgical teams following an identical preoperative assessment sheet, with one team performing O-TLIF and the other UBD-TLIF. The cohort comprised 33 males and 31 females, aged 65 to 75 years. Demographic characteristics of the patients, including sex, age, location of lesions, conservative treatment time and follow-up time were collected and analyzed through reviewing the medical records. All participants were able to complete the follow-up visit.

2. Inclusion and Exclusion Criteria

Inclusion criteria are as follows: (1) Patients must present with single-level lesions; (2) All must be undergoing primary surgical intervention; (3) Must not be enrolled in other clinical trials; (4) Must have failed conservative treatment; (5) Must meet surgical indications for UBD or TLIF procedures; (6) Must possess normal mental or cognitive function and provide signed informed consent.

Exclusion criteria are as follows: (1) concurrent severe lumbar disorders; (2) patients with low back pain or lower limb pain of other etiologies; (3) patients with coagulation disorders; (4) patients with concomitant systemic infectious diseases.

Exclusion or withdrawal criteria are as follows: (1) patients experiencing serious adverse events during treatment or follow- up; (2) inadvertently included patients; (3) patients with incomplete follow-up data precluding efficacy assessment; (4) lost to follow-up patients.

Flexion-extension x-rays were taken according to routine principles. The lateral projection was obtained in maximum flexion and extension of the lumbar spine from a standing position with arms crossed on the shoulders and extended knees with feet set to the width of the pelvis during the whole process. Lumbar instability was defined as: sagittal translational motion ≥3 mm or angular change ≥10° between flexion and extension lateral radiographs.

3. Surgical Techniques

1) The surgical procedure of O-TLIF

For O-TLIF surgery, the patient was placed in a prone position on a radiolucent operating table. A long incision will be made in midline (10–15 cm) with the following separation of paraspinal muscles from the midline and the implantation of pedicle screws from both sides. Then decompression will be performed. A cage filled with autologous bone was inserted in the disc space. The wound was copiously irrigated and closed in layers. A negative pressure drainage tube was placed in the decompression side intraoperatively.

2) The surgical procedure of UBD-TLIF

The originally designed UBD system consisted of 2 channels, one endoscopic channel and another working channel. Both channels of the UBD system can be used as working channels and are compatible with both air and water media. The endoscopic channel has a diameter of 3.8 mm and is fitted with a custom 3.6-mm endoscope. The working channel's diameter is adjustable to meet various requirements, with the most frequently utilized sizes being 3.8 mm and 6.5 mm (Figure 1).

The patient was positioned in a prone position on the operating table, and C-arm fluoroscopy was utilized to verify the anatomical landmarks, including the lumbar spinous process, the pedicles, the intervertebral space, and the superior articular process. Under fluoroscopic guidance, a specially designed puncture needle was inserted. Once the puncture needle is positioned optimally, a 3-cm skin incision is made around the needle site. A series of dilators of increasing diameter are then introduced to expand the soft tissues. Subsequently, we then inserted a 6.5-mm UBD working channel, and an intraspinal endoscope is introduced through the endoscopic channel to provide visualization (Figure 2).

Endoscope and instruments are inserted in turn. Hypertrophic soft tissue, the medial facet and ligamentum flavum are removed to expose the nerve root. The 6.5-mm cannula is exchanged for a 13.1-mm UBD sleeve; the nerve root and annulus are retracted, the disc and cartilaginous endplates are curetted, and the cavity is packed with autologous bone chips. An allogeneic cage is then inserted. Final fluoroscopy confirms adequate root decompression, satisfactory cage position and no active bleeding. The field is irrigated, instruments removed, percutaneous pedicle screws inserted, rods connected, nuts tightened and the wound closed in layers (Figure 3).

4. Statistical Analysis

The Kolmogorov-Smirnov test was utilized to assess the normality of all variables. The demographic and clinical characteristics were demonstrated as mean±standard deviation for normal distributed continuous variables (e.g., age) and percentages for dichotomous variables (e.g., sex). The group differences were then compared using either a Student t-test for continuous variables or a chi-square test for categorical variables. All analyses were performed using IBM SPSS Statistics ver. 20.0 (IBM Co., USA). Statistically significant results were defined as those with p-values less than 0.05.

RESULTS

A total of 64 patients were enrolled in our study, including 32 cases in UBD-TLIF group (69.47±7.42 years) and 32 cases in O-TLIF group (68.10±7.93 years). Comparisons of baseline characteristics including age, gender, body mass idex, disease duration, affected vertebrae and lesion type between the 2 groups showed no statistically significant differences (p>0.05), as shown in Table 1.

The UBD-TLIF group exhibited lower intraoperative blood loss than the TLIF group, with shorter incision length, bed rest duration, and hospital stay compared to the O-TLIF group (p<0.05). There were no statistically significant differences between the UBD-TLIF and O-TLIF groups in terms of operative time (p>0.05), as shown in Table 2.

Clinical outcomes were evaluated using visual analogue scale (VAS) and Oswestry Disability Index (ODI) scores (Table 3). There were no significant differences in VAS scores for back and leg pain before surgery or at 3 and 12 months postoperatively between the UBD-TLIF and O-TLIF groups (p>0.05). However, patients undergoing UBD had significantly lower back and leg VAS scores than those in the O-TLIF group at 1 day postoperatively (1.43±0.63 vs. 3.03±0.72, p<0.001, 2.20±0.45 vs. 3.83±0.51, p<0.001). There were no significant differences in ODI scores between these 2 groups (p>0.05), demonstrating that both surgical procedures could improve postoperative functional recovery.

Then, we evaluated the satisfaction rate of clinical outcomes at 12 months follow-up according to the modified MacNab criteria. UBD-TLIF group, 23 patients achieved an excellent outcome, 7 achieved a good outcome, and 2 achieved a fair outcome. In the TLIF group, 22 patients achieved an excellent outcome, 9 patients a good outcome, and 1 patient a fair outcome (Table 3). There was no significant difference in satisfaction rates (excellent and good) between the 2 surgical approaches (p=0.458).

Regarding lumbar stability, the intervertebral disc height in both groups was higher at 6 months postoperatively than preoperatively. Additionally, a typical case of L4–5 LDH with lumbar instability is presented, showing pre- and postoperative imaging of the UBD procedure (Figures 4 and 5).

No complications occurred in the UBD-TLIF group. One case in the O-TLIF group developed wound exudate. Pathogenic cultures of the wound secretions were performed at the time of abnormality, the following day, and on the third day, all yielding negative results. The patient achieved delayed healing following debridement.

DISCUSSION

O-TLIF is a commonly employed treatment approach for LDH, and with advances in endoscopic techniques, it has become widely utilized in the management of LDH. Conventional TLIF procedures necessitate execution within working trocars, imposing significant constraints on surgical practice. This is particularly evident when extensive tissue dissection is required postoperatively, especially with the midline lumbar approach, which is highly prone to causing muscle atrophy and loss of trophic function [16]. Controlling venous plexus bleeding is challenging and may cause blurred vision, thereby affecting surgical operations [17]. Moreover, TLIF has fewer indications and presents greater operational challenges for patients with tissue calcification, severe adhesions, or recurrent conditions. Optimizing surgical procedures is therefore essential for improving the prognosis of patients with LDH.

The UBD system comprises a percutaneous endoscopic technique that consists of the working channel and the endoscope channel converging at an angle at the front end [18].Through a single incision, the paraspinal muscles can be traversed to reach the lamina for surgical intervention. This approach is useful not only for routine discectomy and fusion, but also for technically demanding situations such as rigid kyphotic correction, calcification and ossification of the posterior longitudinal ligament, and calcified disc herniation, thereby significantly expanding the indications for endoscopic spinal surgery [3]. The findings of this study indicate that the UBD group experienced less intraoperative blood loss than the O-TLIF group, with shorter incision lengths and hospital stays. This suggests that the application of UBD in elderly patients with LDH may reduce incisional trauma, minimize intraoperative hemorrhage, and promote early postoperative recovery [19,20].

The use of a small-diameter endoscope during UBD surgery provides a larger surgical field of view, allows for real-time adjustment of position and angle, and enables the display of anatomical structures from multiple perspectives, thereby addressing the limitations of single-channel coaxial spinal endoscopy. Furthermore, this procedure is performed through a single incision, facilitates tissue dissection, and effectively controls bleeding, thereby creating favorable conditions for postoperative recovery. Therefore, this may be more beneficial for the recovery of elderly surgical patients.

In short, our study suggested that both surgical approaches significantly improved patients' daily lives, as evidenced by ODI scores that were significantly lower than preoperative levels in both groups. Similarly, there was no statistical difference in clinical outcomes based on the modified MacNab criteria between UBD-TLIF and O-TLIF.

CONCLUSION

UBD-TLIF and O-TLIF treatment for LDH and lumbar instability with elderly patients can improve patients' lumbar function, ensure safety, while UBD-TLIF with a small incision can reduce intraoperative bleeding, decrease early postoperative pain, and speed up early recovery.

NOTES

Conflicts of interest

The authors have nothing to disclose.

Funding/Support

Modify to-This work was sponsored by Science and Technology Commission of Shanghai Municipality (grant numbers 23015820300).

Figure 1.

The originally designed uniportal bichannel dual-media spinal endoscopy system. (A) The diameter of the endoscopic channel is 3.8 mm, and the diameter of the dorsal working channel is 3.8 mm. (B) The diameter of the dorsal working channel is 6.5 mm.

Figure 2.

UBD-TLIF surgical procedure. (A) Insertion of the puncture needle. (B) The position of the specially designed puncture needle was confirmed using intraoperative fluoroscopy. (C) The working channel was positioned adjacent to the target site, and a trephine was used to perform foraminoplasty. UBD-TLIF, uniportal bichannel dual-media spinal endoscopic technique-transforaminal lumbar interbody fusion.

Figure 3.

(A) The specially designed trephine was used to remove part of the ventrolateral region of the superior articular process. (B) The trephine was used to remove the superior articular process under endoscopic visualization. (C) The intervertebral space was prepared. (D and E) The endplate was prepared. (F) A polyetheretherketone (PEEK) cage was implanted. (G) The PEEK cage was inserted into the intervertebral space and its position was confirmed using x-ray imaging.

Figure 4.

Preoperative and postoperative imaging following UBD surgery. (A) Preoperative anteroposterior x-ray in the prone position. (B) Cross-sectional CT image of the lumbar spine. (C) Postoperative anteroposterior x-ray in the prone position. UBD, uniportal bichannel dual-media; CT, computed tomography.

Figure 5.

Typical wound appearance on postoperative day 3. (A) O-TLIF group. (B) UBD-TLIF group. O-TLIF, open transforaminal lumbar interbody fusion; UBD-TLIF, uniportal bichannel dual-media spinal endoscopic technique-transforaminal lumbar interbody fusion.

Table 1.

Comparison of baseline information between the 2 groups

Variable	UBD (N=32)	TLIF (N=32)	p-value
Age (yr)	69.47±7.42	68.10±7.93	0.589
Sex			0.795
Male	17 (53.1)	16 (50)
Female	15 (46.9)	16 (50)
Location of lesions			0.485
L3–4	5 (15.6)	4 (12.5)
L4–5	13 (40.6)	16 (50.0)
L5–S1	14 (43.8)	12 (37.5)
Conservative time (mo)	3.93±1.07	4.40±1.210	0.294
Follow-up time (mo)	14.23±2.89	13.23±2.45	0.451

Values are presented as mean±standard deviation or number (%).

UBD, uniportal bichannel dual-media; TLIF, transforaminal lumbar interbody fusion.

Table 2.

Comparison of general surgical conditions in the 2 groups

Variable	UBD (N=32)	TLIF (N=32)	p-value
Intraoperative duration (min)	101.93±15.19	99.53±13.19	0.213
Length of hospital stay (day)	6.32±1.85	9.63±2.25	<0.001
Amount of bleeding (mL)	41.80±10.42	92.00±15.23	<0.001
Amount of surgical drain (mL)	35.10±10.42	102.00±20.73	<0.001
Incision length (cm)	1.03±0.18	2.72±0.40	<0.001

Values are presented as mean±standard deviation.

UBD, uniportal bichannel dual-media; TLIF, transforaminal lumbar interbody fusion.

Table 3.

VAS and ODI scores

Parameter	UBD (N=32)	TLIF (N=32)	p-value
VAS score for back pain
Preoperative	6.30±0.99	6.43±1.10	0.614
Postoperative 1 day	1.43±0.63	3.03±0.72	<0.001
Postoperative 3 months	1.40±0.52	1.63±0.44	0.092
Postoperative 12 months	1.03±0.41	1.20±0.45	0.652
VAS score for leg pain
Preoperative	6.27±0.83	6.47±0.97	0.385
Postoperative 1 day	2.20±0.45	3.83±0.51	<0.001
Postoperative 3 months	1.47±0.35	1.58±0.38	0.133
Postoperative 12 months	1.27±0.32	1.43±0.47	0.711
ODI score (%)
Preoperative	60.20±5.65	60.43±5.90	0.876
Postoperative 3 months	21.03±2.33	22.50±3.73	0.463
Postoperative 12 months	22.17±3.27	23.83±4.20	0.331
Clinical outcome			0.458
Excellent	23 (71.9)	22 (68.8)
Good	7 (21.9)	9 (28.1)
Fair	2 (6.2)	1 (3.1)
Poor	0 (0)	0 (0)

Values are presented as mean±standard deviation or number (%).

VAS, visual analogue scale, ODI: Oswestry Disability Index; UBD, uniportal bichannel dual-media; TLIF, transforaminal lumbar interbody fusion.

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