Comparing the Efficacy and Safety of Unilateral Biportal Endoscopic Decompression with Percutaneous Endoscopic Lumbar Decompression for Lumbar Degenerative Diseases: A Meta-Analysis

Yuxian Chen; Wei Lin; Shenglin Lei; Yawen You; Xiaoqing Zhang; Yingfei Ma; Dongping Wang

doi:10.1016/j.wneu.2024.04.093

Comparing the Efficacy and Safety of Unilateral Biportal Endoscopic Decompression with Percutaneous Endoscopic Lumbar Decompression for Lumbar Degenerative Diseases: A Meta-Analysis

World Neurosurg. 2024 Apr 22:S1878-8750(24)00665-X. doi: 10.1016/j.wneu.2024.04.093. Online ahead of print.

Authors

Yuxian Chen¹, Wei Lin¹, Shenglin Lei¹, Yawen You², Xiaoqing Zhang¹, Yingfei Ma¹, Dongping Wang³

Affiliations

¹ The First Clinical Medical School of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China.
² The Fifth Clinical Medical School of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China.
³ The First Clinical Medical School of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China. Electronic address: wangdongping911@126.com.

PMID: 38657790
DOI: 10.1016/j.wneu.2024.04.093

Abstract

Objective: Unilateral biportal endoscopic decompression (UBED) offers the advantages of minimal tissue damage, operational flexibility, and clear visualization, positioning it as an innovative, minimally invasive endoscopic technique. Nevertheless, the clinical evidence supporting the use of UBED in the treatment of degenerative lumbar diseases (DLD) is limited and conflicting.

Methods: As of October 1, 2023, a comprehensive search was conducted across databases including Web of Science, PubMed, Embase, and the Cochrane Library to identify all published studies on minimally invasive UBED for the treatment of DLD. Data pertaining to patient demographics, fluoroscopy time, operative duration, intraoperative hemorrhage, hospitalization length, visual analog scale (VAS) score for back and leg pain, MacNab criteria, Oswestry Disability Index (ODI), and complication rates were extracted. The Newcastle-Ottawa scale was utilized to assess the quality.

Results: Twelve articles were included, involving 816 patients. The back VAS score (95% confidence interval [CI]: -0.09-0.07, p=0.75), MacNab criteria (95%CI: 0.52-2.3, p=0.82), fluoroscopy time (95%CI: -7.03-0.4, p=0.08), and the incidence of complications (95%CI: 0.5-1.73, p=0.82) were not significantly different, while the leg VAS score (95%CI: 0.01-0.18, p=0.03), ODI score (95%CI: -1.03-0.09, p=0.02), operation time (95%CI: 5.76-20.62, p=0.0005), hospitalization length (95%CI: 0.41-2.76, p=0.008), and intraoperative hemorrhage (95%CI: 21.92-72.44, p=0.0003) were significantly different.

Conclusions: UBED offers superiority in ODI, flexibility, and visual field clarity. Conversely, percutaneous endoscopic lumbar decompression presents advantages in terms of operation duration, blood loss, hospitalization length, and leg VAS score. These factors should be thoroughly considered when selecting a surgical approach.

Keywords: Unilateral biportal endoscopic decompression; lumbar degenerative diseases; meta-analysis; percutaneous endoscopic lumbar decompression.