Advantages of 12° Endoscope in Unilateral Biportal Endoscopic Surgery for Lumbar Disc Herniation.

Objective: This study introduces the application of a 12° endoscope in unilateral biportal endoscopic (UBE) decompression surgery for lumbar disc herniation and discusses its advantages in UBE procedures.

Methods: From December 2019 to December 2020, 75 patients (33 men and 42 women) were treated with UBE decompression using a 12° endoscope. Patient ages ranged from 26 to 78 years (mean 53.2). Pre- and postoperative visual analog scale (VAS) scores for low back and leg pain were recorded. Surgical outcomes were evaluated using MacNab criteria, with operative time and complications documented.

Results: The 12° endoscope demonstrated superior maneuverability with a distortion-free visual field. Compared with 30° endoscopes, it showed better applicability within the anatomical working triangle while providing broader visualization than 0° endoscopes. This enabled effective decompression of the superior articular process medial edge, nerve root canal, and lateral recess. Low back pain VAS scores decreased from 7.3 ± 1.3 to 1.9 ± 1.2 (P < 0.001), while leg pain scores improved from 8.1 ± 1.8 to 1.6 ± 1.0 (P < 0.001). At the 12-month follow-up, MacNab criteria outcomes were excellent in 65.3%, good in 25.3%, and unsatisfactory in 9.3% of cases (χ ² test, P = 0.002).

Conclusion: The 12° endoscope demonstrates clinical value as a feasible, safe, and effective option for UBE surgery in lumbar disc herniation treatment.

Clinical relevance: Key clinical advantages of the 12° endoscope include direct visualization of key anatomical structures, minimized bone resection (particularly at the medial spinous process base), and a reduction in instrument crowding. These technical benefits contribute to effective decompression, improved patient outcomes (as measured by VAS and MacNab criteria), and potentially a shorter learning curve for surgeons adopting the UBE technique.

Level of evidence: 3: