Meta-analysis of efficacy and safety comparisons between unilateral biportal endoscopy and percutaneous endoscopy in the treatment of cervical spondylotic radiculopathy

English Keywords:Cervical spondylotic radiculopathy  Unilateral biportal endoscopy  Percutaneous endoscopy  Meta-analysis

English Abstract:

  【Abstract】 Objectives: To compare the efficacy of unilateral biportal endoscopy(UBE) versus percutaneous endoscopy(PE) for treating cervical spondylotic radiculopathy(CSR) using meta-analysis. Methods: A comprehensive search was conducted in PubMed, Embase, Cochrane Library, Web of Science, China National Knowledge Infrastructure(CNKI), Wanfang Database, and China Biomedical Literature Database for studies published since their inceptions up to June 2025 that reported clinical outcomes and complications of UBE and PE in the treatment of CSR. The Cochrane Risk of Bias tool was used to assess randomized controlled trials, while the Newcastle-Ottawa scale(NOS) was applied to evaluate retrospective studies. Outcome indicators were extracted including visual analogue scale(VAS) scores for neck and upper limb pain, neck disability index(NDI), operative time, intraoperative blood loss, length of hospital stay, incision size, preoperative and postoperative serum creatine kinase(CK) and C-reactive protein(CRP) levels, and postoperative complications. Meta-analysis was performed using Review Manager 5.4 software. Results: A total of 10 literatures were included, all of which were retrospective studies, and six studies were 8 points of NOS scores, three studies were 7 points, and one study was 6 point, indicating moderate to high quality. The total sample comprised 782 patients(UBE: n=388; PE: n=394). Meta-analysis revealed no significant difference in operative time between groups[MD= -6.67, 95%CI(-17.47, 4.13), P=0.23]. Intraoperative blood loss was significantly lower in the PE group[MD=10.86, 95%CI(0.64, 21.07), P=0.04]. No significant difference was observed in postoperative length of hospital stay[MD=0.49, 95%CI(-0.00, 0.99), P=0.05]. Incision size was significantly smaller in the PE group[MD=7.13, 95%CI(1.76, 12.50), P=0.009]. There were no significant intergroup differences in postoperative CK[MD=1.25, 95%CI(-5.08, 7.75), P=0.70] or CRP levels[MD=-0.03, 95%CI(-0.08, 0.02), P=0.23]. There was no significant difference in neck pain VAS scores at various timepoints between the two groups[MD=-0.07, 95%CI(-0.17, 0.04), P=0.20]. However, the UBE group was significantly lower in upper limb pain VAS scores at 3 months postoperatively[MD=-0.14, 95%CI(-0.26, -0.01), P=0.03]. No significant differences were found in NDI scores across follow-up periods[MD=-0.24, 95%CI(-0.50, 0.02), P=0.07] or in complication rates[OR=1.02, 95%CI(0.51, 2.03), P=0.95]. Conclusions: Both UBE and PE operations are effective and safe in the treatment of CSR. The PE technique is associated with less intraoperative blood loss and smaller incisions, while UBE provides superior improvement in upper limb pain at the 3-month follow-up.