Unilateral biportal endoscopic spine surgery for lumbar spinal stenosis: a systematic review and meta-analysis

- OBJECTIVE: Lumbar spinal ste-nosis is the most common spinal degenerative disease in patients over 60 years, and the uni-lateral biportal endoscopic (UBE) spine surgery treatment of lumbar spinal stenosis (LSS) has achieved preliminary clinical results. This sys-tematic review and meta-analysis aimed to re-veal the clinical efficacy of UBE for LSS and pro-vide evidence for clinical practice. MATERIALS AND METHODS: PubMed, Em -base, Web of Science, and Cochrane databas-es were searched for literature. The papers se-lected were those published from inception till October 2021. The selected pieces of liter-ature were graded for evidence using the Ox-ford Centre for Evidence-Based Medicine: Levels of Evidence (March 2009). Outcomes mea-sures were operation time, blood loss, compli-cation rate, admission period, Visual Analogue Scale (VAS)-back, VAS-leg, and Oswestry Dis-ability Index (ODI) score, and radiological out-comes. The mean comparisons were based on VAS and ODI scores. RESULTS: A total of 823 patients with a sin-gle LSS segment were included from the select-ed nine studies. There were nine studies com-paring UBE clinical outcomes and micro-endo-scopic unilateral laminotomy for bilateral decom-pression (M-ULBD). The meta-analysis revealed that the UBE group had better VAS-leg and-back scores in the first week postoperatively [total: mean difference (MD) =-0.96, 95% confidence interval (CI):-1.19,-0.74, p < 0.00001; total: MD =-1.69, 95% CI:-1.93,-1.45, p < 0.00001], 1st month postoperatively (total: MD =-0.35, 95% CI:-0.61,-0.08, p = 0.01; total: MD =-0.40, 95% CI:-0.68,-0.12, p = 0.005), 6th month postoperatively (total: MD =-0.22, 95% CI:-0.35,-0.08, p = 0.002; total: MD =-0.24, 95% CI:-0.40,-0.07, p = 0.005), and UBE group also performed better in ODI score at 1st month postoperatively (total: MD =-3.36, 95% CI:-4.26,-2.46, p < 0.00001). There was no signif-icant difference in VAS-leg and-back scores be-tween both groups at the 3rd and 12th month post-operatively, and ODI scores did not significantly differ between both groups at 3, 6, and 12 months postoperatively (all p > 0.05). CONCLUSIONS: UBE has achieved good pre-liminary clinical results and may be a minimal-ly invasive alternative surgery for patients with single segmental LSS.