Uniportal Versus Biportal Endoscopic Decompression for the Treatment of Lumbar Spinal Stenosis: A Systematic Review and Updated Meta-Analysis.

Abstract

Study DesignSystematic review and meta-analysis.ObjectiveAlthough uniportal and biportal endoscopic decompression have emerged as promising minimally invasive options for the management of lumbar spinal stenosis (LSS), their relative advantages remain debated. This systematic review and meta-analysis aims to evaluate the efficacy and safety of both approaches in LSS treatment.MethodsIn adherence to the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) guidelines, we systematically searched PubMed, Embase, Cochrane Library, and Web of science for randomized controlled trials and observational studies comparing the outcomes of uniportal and biportal endoscopic techniques for LSS treatment. Meta-analysis was performed using a random-effects model.ResultsA total of 11 studies were included, comprising 1199 patients. Biportal endoscopy was associated with a significantly lower operation time (<i>P</i> < .01), Oswestry Disability Index (ODI) at 12 months (<i>P</i> < .01), and higher postoperative dural sac area (<i>P</i> < .01) and dural sac area expansion (<i>P</i> = .02). There were no significant differences between groups in intraoperative blood loss, hospitalization time, back pain, leg pain, or ODI at other timepoints, ipsilateral facetectomy angle, and overall complications, including dural tear, infection, postoperative hematoma, lower limb numbness, and nerve root injury.ConclusionIn this meta-analysis, biportal endoscopic decompression demonstrated significantly lower operation time, ODI at 12 months, and higher postoperative dural sac area and dural sac area expansion, although both techniques showed similar safety profiles and complication rates. Further high-quality studies are needed to better assess the advantages of both techniques for LSS treatment.