Unilateral Biportal Endoscopic Transpedicular Decompression for Thoracolumbar Burst Fractures With Neurological Compromise: A Retrospective Case Series

Objective: Thoracolumbar burst fractures with neurological deficits remain surgically challenging, particularly when retropulsed fragments cause severe spinal canal compromise. This study evaluated the feasibility and clinical outcomes of unilateral biportal endoscopic (UBE) transpedicular decompression combined with percutaneous stabilization for neurologically symptomatic thoracolumbar burst fractures.Methods: A retrospective review was conducted in 13 consecutive patients with thoracolumbar burst fractures and neurological deficits who underwent UBE-assisted transpedicular decompression and percutaneous pedicle screw fixation between January 2021 and December 2024. Fractures were classified using the AO Spine classification system and the Thoracolumbar Injury Classification and Severity Score. Clinical outcomes included improvement in American Spinal Injury Association (ASIA) grade, visual analogue scale score, and normalized Oswestry Disability Index score. Radiological outcomes included correction of canal compromise and kyphotic angle.Results: Neurological status improved in most patients. Among the 13 neurologically symptomatic patients, 11 (84.6%) improved by at least one ASIA grade. Postoperative neurological recovery was also observed in patients who presented with complete neurological deficit (ASIA grade A, n=3), although this finding should be interpreted cautiously because of the small sample size and retrospective design. At follow-up, 4 patients (30.8%) had normal neurological function (ASIA grade E). Urinary incontinence was present preoperatively in 3 patients and resolved completely after decompression. No surgical site infection, dural tear, neurological deterioration, or instrumentation-related complication was observed.Conclusion: UBE-assisted transpedicular decompression combined with percutaneous stabilization appears to be a feasible minimally invasive option for selected patients with thoracolumbar burst fractures and neurological deficits. Careful patient selection remains essential, particularly when severe canal compromise, direct neurological compression, or posterior ligamentous complex disruption is present and direct decompression may be preferable to indirect reduction alone.