A novel fully visualized transparent channel in posterior uniportal endoscopic spine surgery: a paradigm shift for nerve root exposure and decompression under direct visualization.

Abstract

The aim of this study was to explore the technical advantages and clinical efficacy of the fully visualized transparent channel in posterior uniportal endoscopic spine surgery for direct nerve root exposure. A retrospective analysis was conducted on 120 patients with lumbar spinal stenosis who underwent posterior uniportal endoscopic spine surgery between January 2022 and December 2023. Patients were divided into a transparent channel group (60 cases) and a metal channel group (60 cases). A polypropylene/polyamide 6 nanocomposite transparent channel system was used in the transparent channel group, whereas a traditional titanium alloy channel was used in the metal channel group. The two groups were compared in terms of surgical field coverage (structural similarity index measure [SSIM]), nerve root traction time, intraoperative blood loss, operation time, postoperative complications, and follow-up outcomes (visual analog scale, Oswestry Disability Index, and Macnab scores). The surgical field coverage in the transparent channel group was significantly higher than that in the metal channel group (SSIM 0.89 ± 0.05 vs 0.52 ± 0.08, p < 0.001). Nerve root traction time (2.3 ± 0.6 minutes vs 4.1 ± 1.1 minutes, p < 0.01) and intraoperative blood loss (18.5 ± 3.2 mL vs 24.7 ± 4.5 mL, p < 0.05) were significantly reduced. The incidence of postoperative nerve irritation signs was 0% in the transparent channel group and 10% in the metal channel group (p < 0.01). The excellent/good rates of Macnab scores at 1 year postoperatively were 96.7% versus 88.3% (p < 0.05). The fully visualized transparent channel significantly improves surgical field clarity and operational safety, providing a more surgically aligned minimally invasive solution for posterior endoscopic spine surgery.