Insights into posterior cervical biportal endoscopic spine surgery outcomes in radiculopathy: a systematic review and meta-analysis.

Abstract

Posterior cervical biportal endoscopic spine surgery (PCBESS), which enables selective decompression through two ipsilateral portals, has emerged as a minimally invasive option for treating cervical radiculopathy secondary to foraminal stenosis and/or disc herniation. This study aimed to assess the efficacy and safety of PCBESS in cervical radiculopathy. A systematic search of the ScienceDirect, PubMed, Google Scholar, and Cochrane databases was conducted to identify longitudinal studies published up to September 2025. Data on patient demographics, perioperative clinical parameters, and complication rates were extracted. Meta-analyses were performed using random-effects models in STATA software. Fourteen studies comprising 712 patients (62.5% male; mean age, 54.78±1.7 years) were included. The mean operative time was 85.88±32.46 minutes, mean blood loss was 84.89±27.81 mL, and mean hospital stay was 4.45±1.33 days. The overall surgical success rate was 91%±7% (MacNab "excellent-good"), with a 3%±2% reoperation rate. Significant improvements were observed in Visual Analog Scale (VAS) pain scores (mean differences [MD], -4.77; 95% confidence intervals [CI], -6.07 to -3.47; p<0.001), Neck Disability Index scores (MD, -27.07; 95% CI, -32.83 to -21.30; p<0.001), and segmental range of motion (MD, 0.55; 95% CI, 0.27-0.84; p<0.001). The overall complication rate was 7%±3%, most commonly dural tears, epidural hematomas, and transient paralysis. Multi-level PCBESS exhibited a higher complication rate than single-level PCBESS (18%±10% vs. 4%±2%, p<0.001). Outcomes were comparable to those of uniportal endoscopic surgery. PCBESS is a safe and effective treatment option for cervical radiculopathy, offering significant pain and functional improvement, low reoperation and complication rates, and outcomes comparable to uniportal endoscopic surgery.