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Clinical outcomes of uniportal compared with biportal endoscopic decompression for the treatment of lumbar spinal stenosis: a systematic review and meta-analysis

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Abstract

Study design

Systematic review and meta-analysis.

Objectives

Lumbar spinal stenosis (LSS) treatment has evolved with the introduction of minimally invasive surgery (MIS) techniques. Endoscopic methods take the concepts applied to MIS a step further, with multiple studies showing that endoscopic techniques have outcomes that are similar to those of more traditional approaches. The aim of this study was to perform an updated meta-analysis and systematic review of studies comparing the outcomes between both available endoscopic techniques (uni and biportal) for the treatment of LSS.

Methods

Following PRISMA guidelines, we conducted a systematic literature search and compared the randomized controlled trials and retrospective studies of uniportal and biportal endoscopy in the treatment of LSS from several databases. Bias was assessed using quality assessment criteria and funnel plots. Meta-analysis using a random-effects model was used to synthesize the metadata. The authors used Review Manager 5.4 to manage the date and perform the review.

Results

After a preliminary selection of 388 studies from electronic databases, the full inclusion criteria were applied; three studies were found to be eligible for inclusion. There were 184 patients from three unique studies. Meta-analysis of visual analog scale score for low back pain and leg pain showed no significant difference at the final follow-up (P = 0.51 and P = 0.66). ODI score after biportal surgery was lower than uniportal surgery [SMD = 0.34, 95% CI (0.04, 0.63), P = 0.02]. The mean operation time was similar in the unilateral biportal endoscopy (UBE) and uniportal groups (P = 0.53). The UBE group was associated with a shorter length of hospital stay (P = 0.05). Complications were similar in both groups (P = 0.89).

Conclusions

Current evidence shows no significant differences in most clinical outcomes between uniportal and biportal surgery. UBE may have a better ODI score at the end of the follow-up compared to uniportal. Further studies are required before drawing a definite conclusion.

Study registration

PROSPERO prospective register of systematic reviews: Registration Nº. CRD42022339078, Available from: https://www.crd.york.ac.uk/prospero/displayrecord.php?ID=CRD42022339078

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Authors and Affiliations

  1. Servicio de Neurocirugía, Hospital Universitario Virgen del Rocío, Av. Siurot S/N, 41013, Seville, Spain

    Ariel Kaen

  2. Neurosurgery department, GOOD MOONHWA HOSPITAL, Busan, Korea

    Man Kyu Park & Sang-Kyu Son

Authors
  1. Ariel Kaen
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Correspondence to Ariel Kaen.

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Appendix 1

Appendix 1

The search strategy was:

("UBE"[All Fields] OR ("biportal"[All Fields] AND ("endoscope s"[All Fields] OR "endoscoped"[All Fields] OR "endoscopes"[MeSH Terms] OR "endoscopes"[All Fields] OR "endoscope"[All Fields] OR "endoscopical"[All Fields] OR "endoscopically"[All Fields] OR "endoscopy"[MeSH Terms] OR "endoscopy"[All Fields] OR "endoscopic"[All Fields]))) AND ("decompress"[All Fields] OR "decompressed"[All Fields] OR "decompresses"[All Fields] OR "decompressing"[All Fields] OR "decompression"[MeSH Terms] OR "decompression"[All Fields] OR "decompressions"[ All Fields] OR "decompressive"[All Fields]).

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Kaen, A., Park, M.K. & Son, SK. Clinical outcomes of uniportal compared with biportal endoscopic decompression for the treatment of lumbar spinal stenosis: a systematic review and meta-analysis. Eur Spine J 32, 2717–2725 (2023). https://doi.org/10.1007/s00586-023-07660-1

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