Unilateral biportal endoscopic debridement with antibiotic-loaded cement beads implantation for lumbar spinal infection: a preliminary report on feasibility and early clinical outcomes

Abstract

Objective: A preliminary evaluate was conducted on the feasibility and clinical efficacy of unilateral biportal endoscopic (UBE) debridement combined with intervertebral antibiotic-loaded cement beads (ALCBs) implantation for lumbar spinal infection.

Methods: We retrospectively analyzed 12 patients with lumbar spinal infections who underwent the procedure between March 2021 and June 2024. Surgical details and complications were documented. Clinical outcomes were evaluated using VAS for pain, ODI, ASIA impairment scale, inflammatory markers, and radiographic parameters, which were measured at multiple timepoints before and after surgery.

Results: All 12 patients successfully underwent the procedure. The mean operative time was 85.58 ± 13.15 minutes, with an estimated blood loss of 51.83 ± 11.50 mL and a mean hospital stay of 6.50 ± 1.45 days. The average follow-up period was 16.50 ± 4.20 months. Significant improvements were observed in all clinical and laboratory outcomes (all overall P< 0.05). Back pain VAS decreased from 6.50 ± 1.17 preoperatively to 2.50 ± 1.72 at final follow-up; ODI improved from 67.42 ± 2.27 to 19.17 ± 3.76. Inflammatory markers also showed significant reductions: WBC (13.47 ± 4.12 to 8.17 ± 0.85 ×10⁹/L), ESR (59.33 ± 16.04 to 12.33 ± 4.42 mm/h), CRP (71.63 ± 25.56 to 3.42 ± 1.86 mg/L), and PCT (1.59 ± 1.06 to 0.04 ± 0.02 ng/ml). ASIA grades improved significantly (preoperative vs. final follow-up, P< 0.05). Radiographically, intervertebral height was maintained (IHI from 0.19 ± 0.04 to 0.23 ± 0.02), and segmental range of motion decreased from 8.02 ± 1.46° to 2.85 ± 1.10° (P< 0.05). 75% of patients achieved spontaneous anterior bony fusion at final follow-up. No complications such as cauda equina injury, cerebrospinal fluid leakage, or pars interarticularis fracture occurred. The clinical success rate was 83%.

Conclusion: This preliminary study suggests that for carefully selected patients with lumbar spinal infections, the combined UBE debridement and ALCB implantation technique may represent a feasible and promising minimally invasive option, offering thorough debridement, sustained local antibiotic delivery, and mechanical support. These initial findings, based on a small single-center series, warrant validation through prospective comparative trials.

Keywords: antibiotic-loaded cement beads; clinical efficacy; lumbar spine; minimally invasive surgery; spinal infection; unilateral biportal endoscopy.