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Surgical Closure of Equine Abdomen, Prevention, and Management of Incisional Complications

Surgical Closure of Equine Abdomen, Prevention, and Management of Incisional Complications

Published on: May 10, 2024

Complications and their prevention in unilateral biportal endoscopy: a systematic review with narrative insights and

Xavier A Santander^1,2, Martin N Stienen^3,4, Stefan Motov^3,4

¹Instituto Clavel, Madrid, Spain. xavier.santander@institutoclavel.com.

Acta Neurochirurgica

|February 2, 2026

Abstract

Purpose:

Unilateral biportal endoscopy (UBE) has expanded as a minimally invasive option for spinal decompression, but complication profiles and their optimal management remain inconsistently reported. This review aimed to synthesize evidence on the incidence, prevention, and management of UBE-related complications and to propose practical management algorithms.

Methods:

A PRISMA-aligned search of PubMed, Scopus, Web of Science, and Ovid identified studies (2020-2025) reporting perioperative complications in UBE. Primary inclusion criteria were biportal endoscopic spinal procedures with ≥ 50 patients and extractable complication data; secondary reviews were included for contextual synthesis. Levels of evidence (Oxford CEBM) and risk of bias (Newcastle-Ottawa Scale) were assessed for primary cohorts. Crude pooled incidences were calculated from primary cohorts only; secondary literature was analyzed qualitatively.

Results:

Eighteen studies met inclusion criteria: eight primary UBE cohorts (3,433 lumbar cases) and ten secondary reviews. Across nine lumbar cohorts, crude pooled incidences were 2.4% for dural tear, about 2% for symptomatic epidural hematoma and lesion recurrence, 2.5% for incomplete decompression, 0.09% for surgical site infection, and 1.4% for reoperation, with higher rates early in the learning curve. Cervical and thoracic applications were sparsely reported and not suitable for pooled analysis. Algorithms were constructed for dural tear, epidural hematoma, incomplete decompression, and neural complications.

Conclusion:

Lumbar UBE decompression appears safe and reproducible in experienced hands when standardized technical strategies are applied, but the evidence base is limited by retrospective design, heterogeneity, and concentration in high-volume centers. The proposed algorithms should be regarded as evidence-informed guidance requiring prospective validation in multicenter cohorts.

Keywords:

Algorithms Biportal endoscopy Complications Dural tear Epidural hematoma Incomplete decompression Prevention

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