Efficacy and safety of unilateral biportal endoscopy compared with microscopic decompression in the treatment of lumbar spinal stenosis: A systematic review and updated meta‑analysis

Wang,Yue-Peng; Qin,Shi-Lei; Yang,Su; Xu,Yun-Feng; Han,Peng-Fei

doi:10.3892/etm.2023.12008

Efficacy and safety of unilateral biportal endoscopy compared with microscopic decompression in the treatment of lumbar spinal stenosis: A systematic review and updated meta‑analysis

Authors:
- Yue-Peng Wang
- Shi-Lei Qin
- Su Yang
- Yun-Feng Xu
- Peng-Fei Han
View Affiliations

Affiliations: Department of Orthopaedics, Heping Hospital Affiliated to Changzhi Medical College, Changzhi, Shanxi 046000, P.R. China, Department of Orthopaedics, Changzhi Yunfeng Hospital, Changzhi, Shanxi 046000, P.R. China
Published online on: May 10, 2023 https://doi.org/10.3892/etm.2023.12008
Article Number: 309
Copyright: © Wang et al. This is an open access article distributed under the terms of Creative Commons Attribution License.

Metrics: Total Views: 0 (Spandidos Publications: | PMC Statistics: )

Metrics: Total PDF Downloads: 0 (Spandidos Publications: | PMC Statistics: )

Cited By (CrossRef): 0 citations Loading Articles...

Abstract

The incidence of lumbar spinal stenosis is increasing annually, and with an ever‑aging population and longer life expectancies, this trend will further continue. It is hoped that a more effective treatment can be found so that the patients can be relieved of their pain. The aim of this systematic review and meta‑analysis was to evaluate the effectiveness and safety of unilateral biportal endoscopic surgery (UBE) and microscopic decompression surgery (MD) for the treatment of lumbar spinal stenosis. A literature search of related studies published until April 2022 was performed using PubMed, EMBASE, Cochrane Library, Web of Science, ClinicalTrials.gov, Google Scholar, China National Knowledge Infrastructure (CNKI), and other databases. After filtering of references, 12 eligible studies were identified that compared UBE with MD as a treatment for lumbar spinal stenosis. Data were extracted and analysed using R. A total of 12 articles (four randomized controlled and eight cohort studies) were included, with a total of 1,067 patients: 250 men and 249 women in the UBE group and 290 men and 278 women in the MD group. The meta-analysis showed that the mean intraoperative blood loss in the UBE group [standardized mean difference (SMD)=‑2.10, 95% confidence interval (CI) (‑3.97, ‑0.23), P=0.03] was lower than that in the MD group. The postoperative Visual analogue scale (VAS) score for back pain [SMD=‑0.52, 95% CI (‑0.76, ‑0.27), P<0.01], leg pain [SMD=‑0.30, 95% CI (‑0.51, ‑0.08), P<0.01], postoperative Oswestry disability index [(ODI); SMD=‑0.25, 95% CI (‑0.48, ‑0.03), P=0.03], and postoperative C‑reactive protein [(CRP); odds ratio (OR)=‑0.92, 95% CI (‑1.80, 0.03), P=0.04] were lower than those in the MD group. Complications (OR=0.60, 95% CI (0.37, 0.98), P=0.04) and hospital stay (SMD=‑1.84, 95% CI (‑2.85, 0.83), P <0.01] were also lesser in the UBE group than in the MD group. UBE was preferable to that in the MD group according to the modified MacNab score [OR=2.28, 95% CI (1.28, 4.06), P<0.01]. No significant differences were observed in the operation times between the groups. UBE surgery was found to be a better option for the treatment of lumbar spinal stenosis than MD surgery.

View Figures

View References

1	Hennemann S and de Abreu MR: Estenose degenerativa do canal lombar. Rev Bras Ortop. 56:9–17. 2021.PubMed/NCBI View Article : Google Scholar
2	Deer T, Sayed D, Michels J, Josephson Y, Li S and Calodney AK: A review of lumbar spinal stenosis with intermittent neurogenic claudication: Disease and diagnosis. Pain Med. 20:S32–S44. 2019.PubMed/NCBI View Article : Google Scholar
3	Weinstein NJ, Tosteson TD, Lurie JD, Tosteson ANA, Blood E, Hanscom B, Herkowitz H, Cammisa F, Albert T, Boden SD, et al: Surgical versus nonsurgical therapy for lumbar spinal stenosis. N Engl J Med. 358:794–810. 2008.PubMed/NCBI View Article : Google Scholar
4	Zhu X, Lu J, Xu H, Tang Q, Song G, Deng C, Wu H, Xu Y, Chen H and Wang J: A comparative study between minimally invasive spine surgery and traditional open surgery for patients with spinal metastasis. Spine (Phile Pa 1976). 46:62–68. 2021.PubMed/NCBI View Article : Google Scholar
5	Kanemura T, Satake K, Nakashima H, Segi N, Ouchida J, Yamaguchi H and Imagama S: Understanding retroperitoneal anatomy for lateral approach spine surgery. Spine Surg Relat Res. 1:107–120. 2017.PubMed/NCBI View Article : Google Scholar
6	Lee MJ, Mok J and Patel P: Transforaminal lumbar interbody fusion: Traditional open versus minimally invasive techniques. J Am Acad Orthop Surg. 26:124–131. 2018.PubMed/NCBI View Article : Google Scholar
7	McAfee PC, Garfin SR, Rodgers WB, Allen RT, Phillips F and Kim C: An attempt at clinically defining and assessing minimally invasive surgery compared with traditional ‘open’ spinal surgery. SAS J. 5:125–130. 2011.PubMed/NCBI View Article : Google Scholar
8	Lin GX, Huang P, Kotheeranurak V, Park CW, Heo DH, Park CK, Park JY and Kim JS: A systematic review of unilateral biportal endoscopic spinal surgery: Preliminary clinical results and complications. World Neurosurg. 125:425–432. 2019.PubMed/NCBI View Article : Google Scholar
9	Pao JL, Lin SM, Chen WC and Chang CH: Unilateral biportal endoscopic decompression for degenerative lumbar canal stenosis. J Spine Surg. 6:438–446. 2020.PubMed/NCBI View Article : Google Scholar
10	Choi CM: Biportal endoscopic spine surgery (BESS): Considering merits and pitfalls. J Spine Surg. 6:457–465. 2020.PubMed/NCBI View Article : Google Scholar
11	Pao JL: A review of unilateral biportal endoscopic decompression for degenerative lumbar canal stenosis. Int J Spine Sur. 15 (Suppl 3):S65–S71. 2021.PubMed/NCBI View Article : Google Scholar
12	Selçuk AA: A guide for systematic reviews: PRISMA. Turk Arch Otorhinolaryngol. 57:57–58. 2019.PubMed/NCBI View Article : Google Scholar
13	Lo CKL, Mertz D and Loeb M: Newcastle-ottawa scale: Comparing reviewers' to authors' assessments. BMC Med Res Methodol. 14(45)2014.PubMed/NCBI View Article : Google Scholar
14	Cumpston M, Li T, Page MJ, Chandler J, Welch VA, Higgins JP and Thomas J: Updated guidance for trusted systematic reviews: A new edition of the cochrane handbook for systematic reviews of interventions. Cochrane Database Syst Rev. 10(ED000142)2019.PubMed/NCBI View Article : Google Scholar
15	Guo W, Zhang X, Bao X, Yan K, Qiao H, Zhao H, Dong X and Liao B: Comparison of unilateral double-channel endoscopic technique and microscopic nucleus pulposus excision in the treatment of lumbar spinal stenosis. J Xi'an Jiaotong Univ (Medical Edition). 43:430–435. 2022.(In Chinese).
16	Wang B, He P, Liu X, Wu Z and Fang X: Clinical analysis of unilateral double-channel endoscopy and discoscopy in the treatment of lumbar spinal stenosis. Southeast National Defense Med. 24:142–146. 2022.(In Chinese).
17	Yu W, Zhou L, Liu D, Gu LW, Xue X and Cao H: A preliminary study of unilateral double-channel endoscopy in the treatment of lumbar spinal stenosis. Chin J Minimally Invasive Surg. 21:56–60. 2021.(In Chinese).
18	Aygun H and Abdulshafi K: Unilateral biportal endoscopy versus tubular microendoscopy in management of single level degenerative lumbar canal stenosis: A prospective study. Clin Spine Sur. 34:E323–E328. 2021.PubMed/NCBI View Article : Google Scholar
19	Ito Z, Shibayama M, Nakamura S, Yamada M, Kawai M, Takeuchi M, Yoshimatsu H, Kuraishi K, Hoshi N, Miura Y and Ito F: Clinical comparison of unilateral biportal endoscopic laminectomy versus microendoscopic laminectomy for single-level laminectomy: A single-center, retrospective analysis. World Neurosurg. 148:e581–e588. 2021.PubMed/NCBI View Article : Google Scholar
20	Kim HS, Choi SH, Shim DM, Lee IS, Oh YK and Woo YH: Advantages of new endoscopic unilateral laminectomy for bilateral decompression (ULBD) over conventional microscopic ULBD. Clin Orthop Surg. 12(330)2020.PubMed/NCBI View Article : Google Scholar
21	Min WK, Kim JE, Choi DJ, Park EJ and Heo J: Clinical and radiological outcomes between biportal endoscopic decompression and microscopic decompression in lumbar spinal stenosis. J Orthop Sci. 25:371–378. 2020.PubMed/NCBI View Article : Google Scholar
22	Park SM, Park J, Jang HS, Heo YW, Han H, Kim HJ, Chang BS, Lee CK and Yeom JS: Biportal endoscopic versus microscopic lumbar decompressive laminectomy in patients with spinal stenosis: A randomized controlled trial. Spine J. 20:156–165. 2020.PubMed/NCBI View Article : Google Scholar
23	Choi DJ and Kim JE: Efficacy of biportal endoscopic spine surgery for lumbar spinal stenosis. Clin Orthop Surg. 11:82–88. 2019.PubMed/NCBI View Article : Google Scholar
24	Heo DH, Lee DC and Park CK: Comparative analysis of three types of minimally invasive decompressive surgery for lumbar central stenosis: Biportal endoscopy, uniportal endoscopy, and microsurgery. Neurosurg Focus. 46(E9)2019.PubMed/NCBI View Article : Google Scholar
25	Kang T, Park SY, Kang CH, Lee SH, Park JH and Suh SW: Is biportal technique/endoscopic spinal surgery satisfactory for lumbar spinal stenosis patients?: A prospective randomized comparative study. Medicine (Baltimore). 98(e15451)2019.PubMed/NCBI View Article : Google Scholar
26	Heo DH, Quillo-Olvera J and Park CK: Can percutaneous biportal endoscopic surgery achieve enough canal decompression for degenerative lumbar stenosis? Prospective case-control study. World Neurosurg. 120:e684–e689. 2018.PubMed/NCBI View Article : Google Scholar
27	Alimi M, Hofstetter CP, Pyo SY, Paulo D and Härtl R: Minimally invasive laminectomy for lumbar spinal stenosis in patients with and without preoperative spondylolisthesis: Clinical outcome and reoperation rates. J Neurosurg Spine. 22:339–352. 2015.PubMed/NCBI View Article : Google Scholar
28	Storzer B and Schnake KJ: Microscopic bilateral decompression by unilateral approach in spinal stenosis. Eur Spine J. 25 (Suppl 2):S270–S271. 2016.PubMed/NCBI View Article : Google Scholar
29	Heo DH, Son SK, Eum JH and Park CK: Fully endoscopic lumbar interbody fusion using a percutaneous unilateral biportal endoscopic technique: Technical note and preliminary clinical results. Neurosurg Focus. 43(E8)2017.PubMed/NCBI View Article : Google Scholar
30	Kim JE and Choi DJ: Unilateral biportal endoscopic spinal surgery using a 30˚ arthroscope for L5-S1 foraminal decompression. Clin Orthop Surg. 10:508–512. 2018.PubMed/NCBI View Article : Google Scholar
31	Kim JE and Choi DJ: Clinical and radiological outcomes of unilateral biportal endoscopic decompression by 30˚ arthroscopy in lumbar spinal stenosis: Minimum 2-year follow-up. Clin Orthop Surg. 10:328–336. 2018.PubMed/NCBI View Article : Google Scholar
32	Kim SK, Kang SS, Hong YH, Park SW and Lee SC: Clinical comparison of unilateral biportal endoscopic technique versus open microdiscectomy for single-level lumbar discectomy: A multicenter, retrospective analysis. J Orthop Surg Res. 13(22)2018.PubMed/NCBI View Article : Google Scholar
33	Heo DH, Ha JS, Lee DC, Kim HS and Chung HJ: Repair of incidental durotomy using sutureless nonpenetrating clips via biportal endoscopic surgery. Global Spine J. 12:452–457. 2022.PubMed/NCBI View Article : Google Scholar
34	Kang MS, Chung HJ, Jung HJ and Park HJ: How I do it? Extraforaminal lumbar interbody fusion assisted with biportal endoscopic technique. Acta Neurochir. 163:295–299. 2021.PubMed/NCBI View Article : Google Scholar
35	Kim JE, Choi DJ, Kim MC and Park EJ: Risk factors of postoperative spinal epidural hematoma after biportal endoscopic spinal surgery. World Neurosurg. 129:e324–e329. 2019.PubMed/NCBI View Article : Google Scholar
36	Wang MC, Yu KY, Zhang JG and Wang YP: Progression and clinical application in unilateral biportal endoscopic. Zhonghua Wai Ke Za Zhi. 58:892–896. 2020.PubMed/NCBI View Article : Google Scholar : (In Chinese).