A Meta-analysis of unilateral biportal endoscopic and micro endoscopic surgery in the treatment of lumbar spinal stenosis

English Keywords:Lumbar spinal stenosis  Unilateral biportal endoscopic  Micro endoscopic  Meta-analysis

English Abstract:

  【Abstract】 Objectives: To evaluate the efficacy and safety of unilateral biportal endoscopic surgery(UBES) and micro endoscopic surgery(MES) in the treatment of lumbar spinal stenosis, and to provide evidence for clinical procedure. Methods: Databases including PubMed, Web of Science, Embase, Cochrane Library, Clinical Trials, CNKI, Wanfang, VIP, and CBM Database were searched, which was supplemented with Google Scholar, and the retrieval period was between January 1, 2000 and March 25, 2021. Two reviewers screened the literature independently, extracted data, and evaluated the risk of bias in the included studies. The literature was screened in strict accordance with the inclusion and exclusion criteria, and the extracted data included operation time, intraoperative bleeding, complications after surgery, hospital stay, the amount of C-reactive protein at 2 days and 1 week after operation, the degree of dural dilatation within 1 week after surgery, visual analogue scale(VAS) scores of low back and lower limb pain at 1-2 days, 1-3 months, 6-9 months and 12 months after surgery, Oswestry disability index(ODI) at 1 week, 1-3 months, 6-9 months and 12 months after surgery, modified Macnab criteria at 12 months after surgery, and EuroQol Five Dimensions Questionnaire(5Q-5D) score at 12 months after surgery. The Newcastle-Ottawa scale(NOS) was used to evaluate the quality of the included cohort studies, and the Cochrane risk of bias assessment tool was used to evaluate the quality of the included randomized controlled studies. The Review Manager 5.4.1 software was used for data merging, the binary variables were analyzed by odds ratio(OR), and the continuous variables were analyzed by weighted mean difference(WMD). All merged data were 95% confidence interval(CI), which indicates that P<0.05 with a statistically significant difference. Results: There were 10 studies(4 randomized controlled trial, 6 cohort studies) involving 880 patients. A total of 5 high-quality articles and 5 medium-quality articles were included. Among them, 407 patients were treated by UBES and 473 were treated by MES. The results of Meta-analysis showed: the VAS score of postoperative low back pain in the UBES group was lower than that of the MES group at 1-2 days[WMD=-1.61, 95%CI(-1.91, -1.31), P<0.01], 1-3 months [WMD=-0.90, 95%CI(-1.19, -0.61), P<0.01], 6-9 months[WMD=-0.24, 95%CI(-0.40, -0.07), P<0.01]; The VAS score of lower limb pain was lower than that of the MES group at 1-2 days[WMD=-0.55, 95%CI(-0.83, -0.28), P<0.01], 6-9 months[WMD=-0.22, 95%CI(-0.35, -0.08), P<0.01] after surgery; The length of hospital stay[WMD=-2.21, 95%CI(-3.50, -0.91), P<0.01] and the C-reactive protein at 2 days and 1 week after surgery in the UBES group was lower than that of the MES group; the total complications of the UBES group [OR=0.55, 95%CI(0.32, 0.96), P=0.03] were lower than that of the MES group. There were no statistical differences between the two groups in terms of intraoperative blood loss, dural expansion indexes, VAS scores of low back pain at 12 months after surgery, VAS scores for lower limb pain at 1-3 months and 12 months after operation, as well as ODI within 1 week, 1-3 months, 6-9 and 12 months after operation, modified Macnab criteria, operation time, and 5Q-5D scores(P>0.05). Conclusions: Compared with MES, UBES has the advantages of shorter hospital stay, faster recovery, lower incidence of surgical complications, and less postoperative inflammation. However, the efficacy of the two groups is similar in the 12 months follow-up.