Meta analysis of operations under unilateral biportal endoscopy and uniportal endoscopy in the treatment of lumbar spinal stenosis

English Keywords:Lumbar spinal canal stenosis  Unilateral biportal endoscopy  Uniportal endoscopy  Meta analysis

English Abstract:

  【Abstract】 Objectives: To compare the efficacies of operations under unilateral biportal endoscopy(UBE) and uniportal endoscopy(UE) in the treatment of lumbar spinal stenosis(LSS) with meta analysis. Methods: The clinical controlled studies of UBE and UE in the treatment of LSS were searched in PubMed, Cochrane Library, Web of science, Embase, Medline, CNKI, Wanfang, and VIP database from their establishments to May 2024. Newcastle-Ottawa scale(NOS) was used to evaluate the quality of the included studies. Outcome data including visual analogue scale(VAS) score of lower back and leg pain, Oswestry disability index(ODI), operative time, intraoperative blood loss, length of hospital stay, complications, and dural sac area were extracted and analyzed with Review Manager 5.3 software for meta analysis. Results: A total of 15 articles were included, including 1 prospective cohort study and 14 retrospective studies, which were of medium and high quality according to the NOS. The total sample size was 1277, including 650 patients in the UBE group and 627 patients in the UE group. Meta analysis showed that there was a statistical difference in the operative time between the two groups, and the UBE group was shorter[MD=-12.30, 95%CI(-20.90, -3.71), P=0.005]. There was a no statistically significant difference in intraoperative blood loss[MD=7.41, 95%CI(-0.55, 15.31), P=0.07], length of hospital stay[MD=0.02, 95%CI(-0.09, 0.14), P=0.71], postoperative back pain VAS score[MD=-0.22, 95%CI(-0.45, 0.02), P=0.07], postoperative leg pain VAS score[MD=-0.18, 95%CI(0.39, 0.02), P=0.08], ODI[MD=-0.91, 95%CI(-2.22, 0.39), P=0.17], complication rate[OR=0.75, 95%CI(0.46, 1.24), P=0.27], or preoperative dural sac cross-sectional area[MD=0.37, 95%CI(-3.18, 2.44), P=0.80] between the two groups. However, the dural sac area expansion after operation was statistically larger in UBE group than that in UE group[MD=-12.51, 95%CI(7.44, 17.59), P＜0.00001]. Conclusions: Both operations under UBE and UE can achieve significant clinical efficacy in the treatment of LSS, and UBE is superior to UE in operative time and the degree of spinal canal decompression.