Postoperative thoracic epidural hematoma (PTEH) is a rare and complex condition that can lead to significant neurological deficits, persistent pain, and reduced functional abilities. Despite advancements in minimally invasive techniques such as unilateral biportal endoscopic (UBE) decompression, recurrence of PTEH remains a challenging clinical issue. This case report describes the innovative application of unilateral biportal endoscopy-assisted thoracic interbody fusion to manage recurrent thoracic idiopathic epidural hematoma. We discuss the surgical technique, clinical outcomes, and potential benefits of this method in reducing recurrence and stabilizing the thoracic spine. A 78-year-old woman without comorbidities underwent UBE decompression for symptomatic D11–12 and L1–2 spinal stenosis. She later developed delayed postoperative spinal epidural hematoma (SEH), causing paraparesis and bowel/bladder dysfunction. Despite 2 successful emergency hematoma evacuations with magnetic resonance imaging-confirmed clearance and symptom improvement, recurrences continued to take place, each occurring within shorter intervals. At the third recurrence, occult spinal microinstability was suspected as the cause of persistent bleeding. Unilateral biportal endoscopy-assisted thoracic interbody fusion was performed to address this issue. After fusion surgery, the patient experienced no further hematoma recurrences and fully regained neurological and functional capabilities at the 9-month follow-up. While surgical decompression is the standard for SEH, recurrent or delayed postoperative cases require a tailored approach. This case underscores the importance of considering thoracic interbody fusion for recurrent SEH to address microinstability and ongoing bleeding. Unilateral biportal endoscopy-assisted fusion offers a minimally invasive yet definitive solution, highlighting the need for individualized surgical strategies to achieve optimal outcomes.

Background: Minimally invasive spine surgery techniques, including unilateral biportal endoscopy (UBE), have become popular due to reduced soft tissue trauma and quicker recovery. Traditional lumbar fusion approaches using a single polyetheretherketone (PEEK) or expandable cage present limitations in fusion surface area and sagittal correction. Methods: We developed a novel UBE-assisted lumbar interbody fusion technique utilizing a dual hybrid cage system: a PEEK cage placed contralaterally and an expandable cage inserted ipsilaterally. The procedure was performed in 3 patients with degenerative lumbar disease, and perioperative outcomes were evaluated. Results: All patients experienced significant symptom relief, early ambulation, and radiologic evidence of fusion without complications. The dual-cage configuration improved segmental stability, restored lordosis, and maximized graft integration. Conclusion This dual hybrid cage insertion method in UBE transforaminal lumbar interbody fusion provides a safe, effective, and minimally invasive strategy for lumbar fusion with promising clinical outcomes. Further studies are warranted to validate the long-term results.

Methods: This study included 104 patients who underwent ULIF using the “insert and revolve technique” between July 2019 and September 2022. The patients were followed up for at least 12 months postoperatively. The clinical outcomes were assessed using the Visual Analog Scale (VAS) for leg pain and back pain, Oswestry Disability Index (ODI), and modified McNab’s criteria. Changes in segmental lordosis (SL), intervertebral disc height (IVDH), segmental coronal alignment (SCA), cage subsidence, and fusion grade were evaluated at 6- and 12-month follow-up. Results: The VAS scores for leg and back pain and ODI score showed significant improvement. Based on the Macnab’s criteria, 97 patients showed excellent outcomes and seven demonstrated good outcomes at 12 months. The mean IVDH increased from 6.3±2 to 10±2.1 mm immediately after surgery and 10±1.1 mm at 6 months. SL improved from 9.3°±11.5° to 17.78°±8.1°, while SCA improved from 7.7°±2.1° to 3.4°±1.2° at 1 year. Moreover, 92 and 11 patients showed grade 1 and 2 fusion, respectively, according to the Bridwell grading at 1 year. Conclusions The “insert and revolve technique” facilitates the successful insertion of large cages, contributing to the restoration of disc height and coronal and sagittal spinal correction with favorable fusion rates.