Comparison of Unilateral Biportal Endoscopy Decompression and Microscopic Decompression Effectiveness in Lumbar Spinal Stenosis Treatment: A Systematic Review and Meta-analysis

Abstract

This study aimed to compare the safety and effectiveness between unilateral biportal endoscopy (UBE) technique and microscopic decompression (MD) technique in lumbar spinal stenosis treatment. PubMed, Cochrane Library, Embase, Web of Science, China National Knowledge Infrastructure, and other databases were used to conduct extensive literature searches. RevMan ver. 5.3 software was used for the statistical analysis. Eleven studies were included with 930 patients, including 449 patients in the UBE group and 521 in the MD group. Both techniques revealed similar operative times at −1.77 minutes (95% confidence interval [CI], −7.59 to 4.05 minutes; p=0.55), the postoperative dural expansion area at −1.27 (95% CI, −19.30 to 16.77; p=0.89), the postoperative complications at 0.76 (95% CI, 0.47 to 1.22; p=0.26), the preoperative Visual Analog Scale (VAS) for leg pain, and the last follow-up (>12 months) VAS for leg pain at −0.04 (95% CI, −0.14 to 0.06; p=0.47), the preoperative Oswestry Disability Index (ODI), and the last follow-up (>12 months) ODI scores at −0.18 (95% CI, −0.76 to 0.40; p=0.54), and patient satisfaction (the modified MacNab score) at 1.15 (95% CI, 0.54 to 2.42; p=0.72). However, intraoperative bleeding was lower following the UBE technique at −52.78 mL (95% CI, −93.47 to −12.08 mL; p=0.01) and was shorter following the UBE technique at −3.06 (95% CI, −3.84 to −2.28; p<0.01). UBE and MD technology have no significant differences in efficacy or safety in the treatment of patients with lumbar spinal stenosis based on this meta-analysis. However, the UBE technique has less intraoperative bleeding and a shorter hospital stay. It has a slight advantage and is a better surgical option than the MD technique. It can be an alternative minimally invasive spinal surgery method.

Endoscopic versus microscopic discectomy for pathologies of lumbar spine: A nationwide cross-sectional study from a lower-middle-income country

“…MD is considered the routine approach for MISS for lumbar canal stenosis. [ 19 ] However, the utilization of MD to manage lumbar canal stenosis has fewer limitations, such as difficult instrumentation, probable insufficient decompression, and longer operation time, which can be overcome, to some extent, by biportal endoscopic spinal surgery. [ 19 , 20 ] Nevertheless, the 63.8% spine surgeons preferred to use MD over ED, probably, because of, the theoretical risk to exiting nerves, steep learning curve, and limited ability to extend ED in cases of unexpected hindrances, as mentioned by one of the participants, “MD allows to carry out more of what may be additionally required.”[ 21 ] Among the spine surgeons preferring ED over MD, almost all of them chose interlaminar over transforaminal approach because structures exerting posterior compression over the spinal cord cannot be accessed with the latter in patients with lumbar canal stenosis.…”

A Beginner’s Perspective on Biportal Endoscopic Spine Surgery in Single-Level Lumbar Decompression: A Comparative Study with a Microscopic Surgery

“…Likewise, spinal surgery using an endoscope is likely to have a bigger market in the future; some spine surgeons are already performing fusion surgery using an endoscope. 22 23 24 25 26 27 28 29 30) Spinal surgeons who are not yet trained in endoscopic surgery need to prepare in advance, so they do not fall behind the trend.…”

Treatment Concept and Technical Considerations of Biportal Endoscopic Spine Surgery for Lumbar Spinal Stenosis

“…The best surgical treatment option for lumbar spinal stenosis (LSS) must be decompression [1]. There have been trials, and several techniques have been developed under the name of "sufficient decompression," showing their own benefits and limitations [2][3][4]. In early 1990, subtotal laminectomy with wider decompression showed clinical success rates of 78%-88% in the early postoperative period, which decreased to approximately 70% at 1 year and approximately 50% in 5 years [5,6].…”

“…Biportal ESS uses an arthroscopic system for inspection under higher magnification and brighter illumination, which is different from open wider surgery under naked eyes, requires digging deeper in a dark and narrow path, and faces difficulty in clearly differentiating structural margins as well as securing a working space for instrument handling and careful manipulation of neural structures [ 4 , 23 , 26 , 27 ]. An 8-mm sheathed scope guarantees a panoramic view with a wider range of movement under the sublaminar area and foramen and allows for free movements of the instruments, permitting forceful manipulation of hard bone and adhesive tissue to eliminate pathologies.…”