Optimizing the mathematical model and technical standards for unilateral biportal endoscopic spinal surgery through machine learning-based video analysis.

OBJECTIVE: To enhance the efficacy of the unilateral biportal endoscopic spinal procedure, the spinal triangle concept is proposed, integrating a digital model to establish standardized reference parameters and technical protocols for biportal positioning and incision delineation. METHODS: A retrospective-prospective cohort of 105 patients undergoing UBE for lumbar discectomy and unilateral spinal canal decompression between March 2024 and February 2026 was analyzed. The cohort was stratified into three groups: 35 cases for pilot testing, 35 as controls, and 35 as the experimental group where preoperative incision parameters were calculated using a proprietary algorithmic formula. Surgical procedures were executed and meticulously documented, with subsequent manual data annotation, machine learning-assisted computational analysis, and mathematical modeling to enhance the UBE spinal triangle framework. Surgical outcomes were assessed by attending surgeons via a standardized Likert scale, while patient-reported outcomes (VAS and ODI scores) were systematically recorded at postoperative intervals. Quantitative video-derived metrics underwent rigorous statistical evaluation, including Student's t-tests, multivariate linear regression, logistic regression analysis, and Pearson's chi-square tests. RESULTS: The optimal surgical angle was determined to be within the range of 30°-50°. A standardized predictive formula for incision positioning and interportal distance was established: [Formula: see text]. The experimental group utilizing this formula demonstrated a significant reduction in operative duration and enhanced surgical ergonomics under comparable BMI conditions, with particularly pronounced benefits observed in patients with BMI > 28 or BMI < 18.5. Personalized incision placement and optimized interportal distance contributed to decreased operative time, minimized intraoperative radiation exposure, and improved procedural fluency and surgeon satisfaction. CONCLUSION: In UBE procedures, the existence of an endoscopic triangular working zone was confirmed. The implementation of a standardized predictive formula for incision positioning and interportal distance enhances surgical efficiency and methodological precision.