Unilateral Biportal Endoscopy versus Open Surgery for Thoracolumbar Burst Fractures with Neurological Deficit: A Retrospective Comparative Study.

OBJECTIVES: To compare outcomes of unilateral biportal endoscopy (UBE) decompression with percutaneous pedicle screw fixation (PPSF) versus open surgery for thoracolumbar burst fractures with neurological deficits. METHODS: We retrospectively analyzed 38 patients (T11-L2 burst fractures, ASIA C-D) treated between 2020 and 2024. Eighteen underwent UBE-assisted unilateral laminotomy for bilateral decompression with PPSF (UBE group); 20 received open decompression and instrumentation (Open group). Baseline severity was assessed using TLICS and McCormack scores. Outcomes included perioperative metrics, clinical scores (VAS, ODI) evaluated at 1, 6, and 12 months postoperatively, neurological recovery, and vertebral body (VB) height restoration at 12 months. RESULTS: Baseline characteristics were comparable. Median blood loss was significantly lower in the UBE group (125 vs. 475 mL, P < 0.001), with fewer transfusions (5.6% vs. 40%, P = 0.021) and shorter hospital stays (7 vs. 12 days, P < 0.001). The UBE group demonstrated greater VB height restoration, calculated at the patient level and reported in percentage points (38 vs. 23 percentage points, P = 0.003). Both groups achieved comparable functional and neurological improvements across all follow-up intervals. CONCLUSIONS: UBE combined with PPSF represents a feasible, minimally invasive alternative to traditional open surgery for thoracolumbar burst fractures. In this preliminary cohort, UBE significantly minimized early surgical morbidity and achieved robust anatomical restoration while providing comparable clinical outcomes. Larger prospective studies are required to definitively establish its comparative safety and long-term efficacy.