Delta large-channel endoscopy versus unilateral biportal endoscopy for cervicothoracic junction disc herniation: a prospective randomized controlled trial

BACKGROUND: Due to the obscuration by the sternum, trachea, and major blood vessels, the anterior surgical approach for cervicothoracic junction disc herniation (CTJDH) is extremely challenging. Delta large-channel endoscopy and unilateral biportal endoscopy (UBE) provide posterior decompression and have demonstrated promising clinical potential. This prospective randomized controlled study aims to compare the clinical outcomes of Delta and UBE endoscopic surgeries. METHODS: A total of 63 patients were randomly assigned to either the Delta group (n = 32) or the UBE group (n = 31). The primary outcomes were the Neck Disability Index (NDI) and intraoperative blood loss (IBL). Secondary outcomes included VAS, JOA scores, modified MacNab criteria, operative time, hospital stay duration, perioperative complications, and radiographic parameters. RESULTS: During the follow-up period, 62 patients (98.4%) completed the 6-month assessment. The Delta group consistently demonstrated lower NDI scores than the UBE group. Significant differences were observed at postoperative day 14 (p = 0.040) and one month (p = 0.035), favoring the Delta technique. Intraoperative blood loss was significantly lower in the Delta group than in the UBE group (p < 0.001). At postoperative day 3 (p = 0.037), day 7 (p = 0.034), day 14 (p = 0.041), and 1 month (p = 0.027), neck VAS scores were lower in the Delta group. Operative time was shorter in the UBE group (p < 0.001). Both groups showed significant postoperative increases in the C2-C7 Cobb angle (p < 0.001) and reductions in cervical sagittal vertical axis (cSVA) (p < 0.05). Delta group patients with osteophytes had consistently higher NDI scores than those without osteophytes. CONCLUSION: Both surgical techniques demonstrated favorable safety profiles and clinical efficacy in the treatment of CTJDH. Compared with UBE, the Delta large-channel endoscopic approach resulted in less intraoperative blood loss and faster postoperative recovery, although it required a longer operative time. For patients with CTJDH accompanied by osteophytes or bony overgrowth, UBE provided equally satisfactory outcomes, whereas the Delta technique showed relatively poorer results in such cases. Therefore, the choice of surgical approach should be individualized based on each patient's anatomical characteristics and clinical presentation. Trial registration Name of the registry: Chinese Clinical Trial Registry chictr.org.cn. Unique Identifying number or registration ID: ChiCTR2500097522.