Biportal endoscopic decompression vs. microscopic decompression for lumbar canal stenosis: A systematic review and meta‑analysis

Abstract

Lumbar decompressive surgery is the gold standard treatment for lumbar spinal stenosis. Minimally invasive surgical techniques have been introduced with the aim of reducing the morbidity associated with open surgery. The purpose of the present study was to systematically search the literature and perform a meta-analysis of studies comparing the outcomes between biportal endoscopic technique and microscopic technique for lumbar canal stenosis decompression. A comprehensive search of the PubMed, Google Scholar, Web of Science, Embase and the Cochrane Library databases was performed to identify relevant articles up to 15th of December 2019. Eligible studies were retrieved, data were extracted by two authors independently and risks of bias were assessed. A total of six studies involving 438 patients were selected for review. The results of the pooled analysis indicated similar operative times [mean difference (MD),-3.41; 95% CI,-10.78-3.96; P<0.36], similar complications (MD, 0.70; 95% CI, 0.33-1.46; P=0.34), similar visual analogue scale scores for back and leg pain at the time of the final follow-up and similar Oswestry disability indexes (MD,-0.28; 95% CI,-1.25-0.69; P=0.58) for the two procedures. In conclusion, biportal endoscopic technique is a viable alternative to microscopic technique for lumbar canal stenosis decompression with similar operative time, clinical outcomes and complications.

Current Status of Biportal Endoscopic Decompression for Lumbar Central Stenosis

“…Two similar articles of systematic review and meta-analysis concluded that bi-portal endoscopic technique could be considered as an alternative to the microscopic decompression 20,21) . There were no significant differences in VAS score for leg and back pain, ODI at final follow-up between bi-portal endoscopic decompression and microscopic decompression.…”

Analysis of Risk Factors for Perioperative Hidden Blood Loss in Unilateral Biportal Endoscopic Spine Surgery: A Retrospective Multicenter Study

“…When more levels are fused, the bleeding of the vertebral cancellous bone surface signi cantly increases. Anatomically, the management of hemorrhage in the lumbar spine with rich blood supply, especially the spinal venous plexus, is tricky [11,35,36]. And UBE surgery relies on continuous, large amounts of saline irrigation with certain pressure, resulting in more di culty in adequate hemostasis intraoperatively [11,37].…”

Surgical Outcomes of Microscopic versus Unilateral Biportal Endoscopic Decompression for Lumbar Spinal Stenosis: A Preliminary Report

“…Traditionally, open microsurgical decompression including microscopic decompression has been the gold standard treatment for lumbar spinal stenosis 3,9,15,16) . In recent years, endoscopic spinal surgery for lumbar spinal stenosis has been introduced and progressed 1,10,11,13,14) . In our results, there was no statistically significant difference in VAS-L, VAS-B, or ODI scores at one month or three months follow-up.…”

“…Lumbar spinal stenosis is a clinically symptomatic condition caused by narrowing of the spinal canal that compresses nerve roots 1,14) . Most elderly people experience at least one episode of lower back pain, sciatica, claudication, or walking difficulty during their lives 3) .…”

“…This endoscopic approach was based on the same operative technique as other surgical procedures, such as ULBD 9,13) . The UBE was performed through two separate, small surgical incisions, so surgeons could achieve precise decompression in a clear and magnified surgical field with limited damage to adjacent structures 1,11,12,14) . To date, there are many reports of UBE performance and radiological results, as seen in Park et al and Heo et al 8,13) .…”