Comparison of the Biportal Endoscopic Versus Tubular Approach for the Treatment of Lumbar Degenerative Disease: A Systematic Review and Meta-Analysis.

Abstract

Study DesignSystematic Review and Meta-analysis.ObjectivesLumbar degenerative disease (LDD) is prevalent among aging adults. While tubular retraction is a widely used minimally invasive approach, biportal endoscopic spine surgery has emerged as a potential alternative. This systematic review and meta-analysis compares the clinical outcomes of tubular retraction and biportal endoscopy for decompression procedures (discectomy, laminectomy, laminotomy) and transforaminal lumbar interbody fusion (TLIF) in LDD patients.MethodsA systematic review and meta-analysis of comparative studies was conducted per PRISMA guidelines. A comprehensive search of PubMed, Embase, and Scopus identified relevant studies published before October 7, 2024. Data were analyzed using a random-effects model to assess Oswestry Disability Index (ODI), visual analog scale (VAS) scores for back and leg pain, complication rates, operative time, and length of stay at preoperative, ≤2-weeks postoperative, and ≥1-year postoperative time points.ResultsA total of 772 patients were included (400 tubular, 372 biportal). Biportal endoscopic surgery was associated with a lower complication rate (10.73% vs 15.94%; <i>P</i> < .001) and lower ≤2-week postoperative VAS back pain (2.70 ± 0.27 vs 3.55 ± 0.49; <i>P</i> < .001) relative to tubular spine surgery. Biportal decompression had a lower complication rate (15.13% vs 22.34%; <i>P</i> = .006) but similar patient-reported outcomes. Biportal TLIF had longer operative times (189.93 ± 25.90 vs 145.1 ± 14.90 min; <i>P</i> = .026) but lower complication rates (6.33% vs 9.55%; <i>P</i> = .026) and ≥1-year VAS leg pain (1.88 ± 0.29 vs 2.02 ± 0.26; <i>P</i> < .001).ConclusionsBiportal endoscopy for LDD had lower complication rates and similar patient-reported outcomes relative to tubular retraction, though longer operative times in TLIF subanalysis. Future studies are necessary to validate findings and guide patient-specific decision-making.