Efficacy of posterior unilateral biportal endoscopy versus anterior cervical decompression and fusion in the treatment of cervical spondylotic radiculopathy: a meta-analysis

English Keywords:Unilateral biportal endoscopy  Anterior cervical discectomy and fusion  Cervical spondylotic radiculopathy  Meta analysis

English Abstract:

  【Abstract】 Objectives: To compare the clinical efficacies of posterior unilateral biportal endoscopic(UBE) surgery and anterior cervical discectomy and fusion(ACDF) in treating cervical spondylotic radiculopathy. Methods: A comprehensive review of studies published in PubMed, EMBASE, CNKI, CBM and Wanfang Data up to April 2025 was performed. The studies focused on UBE and ACDF for cervical spondylotic radiculopathy. Two researchers independently screened studies, extracted data, assessed bias risks, and used RevMan 5.4 software for meta-analysis. The outcome indicators included incision length, operative time, hospital stay, intraoperative blood loss, postoperative upper limb/neck pain visual analogue scale(VAS) scores, postoperative neck disability index(NDI), and complication rates. Results: Four studies(three retrospective, one prospective) were included, covering 128 UBE patients and 140 ACDF patients. Meta-analysis showed that UBE group had shorter incisions[MD=-3.74, 95%CI(-3.85, -3.62), P<0.05], shorter surgical time[MD=14.09，95%CI(4.27，23.91), P<0.05], shorter hospital stays[MD=-1.52, 95%CI(-2.38, -0.66), P<0.05], and less intraoperative bleeding[MD=-40.32, 95%CI(-65.76, -14.87), P<0.05] than ACDF group. However, no significant differences were found in postoperative 3-month upper limb pain VAS scores[MD=-0.25, 95%CI(-0.52, 0.03), P=0.08], postoperative 3-month upper neck pain VAS scores[MD=-0.13, 95%CI(-0.50, 0.23), P=0.47], postoperative 3-month NDI[MD=-0.44, 95%CI(-1.84, 0.97), P=0.54], and complications[MD=0.51, 95%CI(0.23, 1.12), P=0.09](all P>0.05). Conclusions: Both UBE and ACDF can effectively relieve neck and upper limb pain, but UBE has advantages in shorter incisions, shorter surgical and hospital stays, and less bleeding.