Fu S, Hou LC, Huang XL, Zhao W, Wang FM, Wang YN. Unilateral biportal endoscopy for minimally invasive spinal fusion: Advancements in biomaterials and clinical outcome optimization. World J Orthop 2025; 16(9): 108931 [DOI: 10.5312/wjo.v16.i9.108931]
Corresponding Author of This Article
Ya-Nan Wang, Adjunct Associate Professor, Associate Chief Physician, Department of Minimally Invasive Spine Surgery, Shandong Wendeng Orthopedic Hospital, No. 1 Fengshan Road, Wendeng District, Weihai 264400, Shandong Province, China. yanan19870104@sina.com
Research Domain of This Article
Orthopedics
Article-Type of This Article
Minireviews
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Orthop. Sep 18, 2025; 16(9): 108931 Published online Sep 18, 2025. doi: 10.5312/wjo.v16.i9.108931
Unilateral biportal endoscopy for minimally invasive spinal fusion: Advancements in biomaterials and clinical outcome optimization
Song Fu, Li-Chuan Hou, Xiao-Ling Huang, Wei Zhao, Feng-Ming Wang, Ya-Nan Wang
Song Fu, Xiao-Ling Huang, Wei Zhao, Feng-Ming Wang, Ya-Nan Wang, Department of Minimally Invasive Spine Surgery, Shandong Wendeng Orthopedic Hospital, Weihai 264400, Shandong Province, China
Li-Chuan Hou, Department of Medical Impact, Shandong Wendeng Orthopedic Hospital, Weihai 264400, Shandong Province, China
Author contributions: Fu S analyzed the data and wrote the manuscript; Hou LC, Huang XL, Zhao W, and Wang FM collected the patient’s clinical data; Wang YN designed the study; all authors read and approved the final version of the manuscript.
Supported by Joint Traditional Chinese Medicine Science and Technology Projects of National Demonstration Zones for Comprehensive Traditional Chinese Medicine, No. GZY-KJS-SD-2023-031.
Conflict-of-interest statement: The authors have no conflicts of interest to declare.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Received: May 12, 2025 Revised: June 2, 2025 Accepted: August 21, 2025 Published online: September 18, 2025 Processing time: 137 Days and 20.7 Hours
Abstract
Lumbar interbody fusion is essential for treating degenerative lumbar diseases. The disadvantages of open surgery have led to the evolution of minimally invasive spine surgery, including endoscopic techniques such as unilateral biportal endoscopy (UBE). Leveraging arthroscopic principles, UBE offers superior visualization and flexibility and expands from decompression to fusion (UBE fusion). However, achieving robust UBE fusion presents challenges, such as suboptimal arthrodesis rates and implant-related complications, requiring more than surgical skill alone. Optimizing UBE fusion critically depends on the effective integration of advanced biomaterials with the surgical technique. This minireview assessed recent advances in UBE, focusing on the development of novel biomaterials, such as functionalized porous, expandable, or double-cage designs, to improve bone regeneration outcomes. These advancements address challenges, like washout of bone graft material and biologics, and utilize growth factors, such as recombinant human bone morphogenetic proteins, while exploring pathway modulation to improve outcomes. We also evaluated clinical optimization strategies involving technical refinements, fluid and hemostasis control, key complication mitigation especially concerning dural tears and hematomas, and technologies such as navigation and robotics. While UBE shows promise particularly for early recovery, its long-term success hinges on these biotechnological advancements. High-quality evidence, especially from randomized controlled trials and long-term studies, is needed to validate integrated strategies and define the optimal role of UBE fusion.
Core Tip: Unilateral biportal endoscopic fusion is a promising minimally invasive technique to treat lumbar degenerative diseases. Achieving optimal long-term outcomes necessitates intelligently integrating advanced biomaterials, such as novel cages (e.g., expandable, double), optimizing grafts, refining surgical techniques, and effectively managing complications (e.g., dural tear, hematoma). This minireview highlighted recent advances in biotechnological integration for optimizing clinical results. Future directions should focus on smart materials and navigation and robotics technologies. There is a critical need for high-quality evidence, particularly randomized controlled trials, to validate these integrated strategies and define the role of unilateral biportal endoscopic fusion.
