Abstract
Introduction:
Uniportal endoscopic spinal surgery offers a minimally invasive approach with potential for enhanced patient outcomes. However, the technical complexity introduces a significant learning curve that can initially affect outcomes. This study evaluates a single surgeon’s transition to endoscopic spine surgery, focusing on outcome optimisation over time.
Methods:
A retrospective review was conducted of 400 consecutive uniportal endoscopic spine surgeries performed by a single surgeon from October 2019 to May 2025. The data analysed included demographics, procedural details, clinical outcomes including Visual Analogue Scale (VAS), Oswestry Disability Index (ODI), Roland-Morris Disability Questionnaire (RMDQ), and EuroQol five-dimension questionnaire (EQ-5D) and complication rates. Patients were stratified into groups of 100 cases to evaluate trends across the learning curve.
Results:
Of the 400 patients the average age was 53.6 ± 17 years, ratio of male to female was 176:224 and BMI 30 ±7 kg/m2. Operative time, estimated blood loss and mean hospital length of stay all decreased from the first 100 cases to the final 100 cases. The overall complication rate declined from 15% to 3%, with only one intraoperative complication in the last 100 cases. Interlaminar cases initially had higher complication rates, but these improved significantly over time. Transforaminal cases showed fewer complications throughout. Patient reported outcomes exhibited marked improvement: mean VAS leg pain scores reduced from 3.2 to 1.6, ODI from 48.2 to 18.7, RMDQ from 14.1 to 5.3, and EQ-5D index scores rose from 0.52 to 0.83.
Conclusion:
This study demonstrates uniportal endoscopic spinal surgery can be safely and effectively integrated into clinical practice despite a steep learning curve. Improvements in efficiency, complication rates, and patient outcomes underscore the importance of mentorship, iterative technique refinement, and consistent outcome tracking in successful adoption