Efficacy and safety of unilateral biportal endoscopy versus other spine surgery: A systematic review and meta-analysis

Background This study aimed to evaluate the efficacy and safety of unilateral biportal endoscopy (UBE) versus other forms of spine surgery. Methods Electronic databases were systematically searched up to February 2022. The authors used Review Manager 5.3 to manage the data and perform the review. Results After the preliminary selection of 239 studies from electronic databases, the full inclusion criteria were applied; 16 studies were found to be eligible for inclusion. These 16 studies enrolled 1,488 patients: 653 patients in the UBE group, 570 in the microendoscopic discectomy group, 153 in the percutaneous endoscopic lumbar discectomy group, and 70 in the posterior lumbar interbody fusion group. UBE was superior to microendoscopic discectomy regarding 1-day Visual Analog Scale(VAS) back pain scores ( P < 0.00001). No difference was found between UBE and microendoscopic discectomy regarding 1-day Visual Analog Scale leg pain scores ( P = 0.25), long-term VAS back pain scores ( P = 0.06), long-term VAS leg pain scores ( P = 0.05), Oswestry Disability Index scores ( P = 0.09) or complications ( P = 0.19). Pooled analysis indicated that UBE was similar to percutaneous endoscopic lumbar discectomy regarding 1-day VAS back pain scores ( P = 0.71), 1-day VAS leg pain scores ( P = 0.37), long-term VAS back pain scores ( P = 0.75), long-term VAS leg pain scores ( P = 0.41), Oswestry Disability Index scores ( P = 0.07) and complications ( P = 0.88). One study reported no difference between UBE and posterior lumbar interbody fusion regarding long-term VAS back pain, long-term VAS leg pain, or Oswestry Disability Index scores. Conclusions UBE is superior to microendoscopic discectomy to relieve back pain 1 day postoperatively. However, these two procedures are similar regarding 1-day leg pain relief, long-term effects, and safety. UBE and percutaneous endoscopic lumbar discectomy are similar regarding 1-day pain relief, long-term effects and safety. More evidence is needed to evaluate the efficacy and safety of UBE versus posterior lumbar interbody fusion.