AccScience Publishing / OTE / Online First / DOI: 10.36922/OTE025480021
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ORIGINAL RESEARCH ARTICLE

Technical aspects and preliminary clinical outcomes of unilateral biportal endoscopic surgery via a far-paraspinal approach for thoracic disc herniation

Ziqiao Liu1 ,  Ying Xiao1 ,  Yuhao Yang1 ,  Hao Wu1 ,  Lekhang Cheang2*
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1 Department of Orthopaedics, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, China
2 Department of Orthopedic Surgery, Centro Hospitalar Conde de São Januário, Macao, China
OTE, 025480021 https://doi.org/10.36922/OTE025480021
Received: 24 November 2025 | Revised: 24 February 2026 | Accepted: 25 February 2026 | Published online: 8 April 2026
© 2026 by the Author(s). This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution -Noncommercial 4.0 International License (CC-by the license) ( https://creativecommons.org/licenses/by-nc/4.0/ )
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Abstract

Thoracic disc herniation (TDH) is a relatively uncommon spinal disorder, and its surgical management remains technically challenging because of the complex regional anatomy and the risk of neural injury. This study evaluates preliminary clinical outcomes of unilateral biportal endoscopic (UBE) discectomy via the far-paraspinal approach (FPA) for TDH and details key surgical technical nuances. A retrospective analysis was conducted on five patients with TDH who underwent UBEFPA discectomy between December 2024 and April 2025. Preoperative neurological examinations showed varying degrees of muscle weakness, sensory deficits, and reduced tendon reflexes in corresponding spinal segments. The lateral offset of FPA was adjusted based on segmental anatomical differences. Intraoperative parameters (operative time, treated level) and postoperative outcomes (hospital stay) were recorded. Clinical efficacy was assessed using the visual analog scale (VAS), Oswestry Disability Index (ODI), and thoracic Japanese Orthopaedic Association (JOA) score. All five surgeries were completed successfully, with an operative time of 60–80 min (mean, 67.5 min). No intraoperative complications or postoperative adverse events occurred. All patients were followed up for 6–12 months (mean, 9.4 months). Postoperative thoracic magnetic resonance imaging confirmed complete resection of herniated nucleus pulposus and adequate neural decompression in all cases. VAS and ODI scores showed sustained decreases, while JOA scores increased progressively at all postoperative time points (all p < 0.001). At six months postoperatively, the VAS score decreased from 6.8 ± 0.8 to 1.2 ± 0.4, the ODI improved from 56.0 ± 5.7% to 9.0 ± 8.5%, and the JOA score increased from 4.6 ± 1.1 to 10.4 ± 1.7. Neurological reassessments during follow-up revealed substantial improvements in sensory disturbances and muscle weakness. With its unique anatomical trajectory, UBE-FPA discectomy offers distinct advantages by preserving spinal stability and reducing nerve injury risk, providing a novel therapeutic option for TDH management.

Keywords
Thoracic disc herniation
Unilateral biportal endoscopy
Far paraspinal approach
Discectomy
Minimally invasive spinal surgery
Funding
This work was financially supported by the Macao Medical Technology Research Association (Fund source: Macao Science and Technology Development Fund; initiated by the First Affiliated Hospital of Jinan University; grand no.: 0003/2024/RIB1). The project funding was specifically used for the clinical research of this study, including clinical data collection, sorting, and statistical analysis.
Conflict of interest
The authors declare that they have no competing interests.
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