Unilateral Biportal Endoscopic Surgery for Tissue Diagnosis and Neural Decompression in Spinal Tuberculosis: Two Cases and a Literature Review

Spinal tuberculosis may present diagnostic challenges and involve neural compression, particularly when an epidural abscess is present.Selected patients may therefore require both tissue diagnosis and neural decompression.We report two cases in which unilateral biportal endoscopic (UBE) surgery allowed tissue sampling, direct visualization of the pathological lesion, and neural decompression in patients with spinal tuberculosis.In Case 1, histopathological examination revealed histiocytic aggregates and positive staining for acid-fast bacilli; in Case 2, polymerase chain reaction testing of the tissue was positive for Mycobacterium tuberculosis.Both patients experienced postoperative pain relief without perioperative complications.Motor strength in Case 1 improved from Medical Research Council grade III to IV+; in Case 2, strength remained at grade IV without neurological deterioration.These cases suggest that UBE may be feasible for selected patients with spinal tuberculosis who require both tissue diagnosis and neural decompression.Patient selection requires particular care when spinal instability, extensive vertebral destruction, or pathology requiring stabilization, reconstruction, or wide debridement is present.