Comparison of clinical outcomes and complications of biportal and uniportal endoscopic decompression for the treatment of cervical spondylotic radiculopathy: A systematic review and meta-analysis

Abstract

Objectives: This study aimed to compare the clinical efficacy and complication rates of decompression with unilateral biportal endoscopy (UBE) and percutaneous endoscopy (PE) in cervical spondylotic radiculopathy (CSR).

Materials and methods: A comprehensive literature review was conducted up to April 2024 across multiple databases, including EMBASE, PubMed, Cochrane Library, China National Knowledge Infrastructure, and Wanfang Data, focusing on clinical studies that compare UBE with PE for posterior foraminotomy and discectomy decompression in CSR. The meta-analysis was performed with an emphasis on evaluating clinical outcomes such as operation time, blood loss, incision length, Neck Disability Index (NDI), Visual Analog Scale (VAS) for neck pain and arm pain, and complications.

Results: Out of an initial 1,041 studies identified from electronic databases, eight were deemed eligible based on title, abstract, and full-text screening. These studies involved 552 patients (269 males, 283 females; mean age: 53.9±11.4 years; range, 30 to 79 years), with 287 in the UBE group and 265 in the PE group. Meta-analysis indicated no significant difference in operation time between UBE and PE (mean difference [MD]=–3.68; 95% confidence interval [CI]:–19.38, 12.02; p=0.65). However, both blood loss (MD=17.01; 95% CI: 2.61, 31.41; p=0.02) and incision length (MD=11.62; 95% CI: 9.23, 14.01; p<0.00001) were significantly lower in the PE group compared to the UBE group. Regarding clinical outcomes, no significant differences were observed between the two groups in terms of NDI (MD=0.12; 95% CI:–0.10, 0.34; 0.28), VAS for neck pain (MD=–0.06; 95% CI:–0.19, 0.06; p=0.32), VAS for arm pain (MD=–0.14; 95% CI:–0.26, –0.01; p=0.84), or complications (OR=1.07; 95% CI: 0.54, 2.10; p=0.85).

Conclusion: Our findings suggest that there are no significant disparities in clinical outcomes between UBE and PE, encompassing NDI, VAS for arm pain, and VAS for neck pain, as well as complication rates. Notably, compared to PE, UBE results in increased bleeding and longer incision lengths when treating CSR, without substantially reducing operation time.

Citation: Li J, Zhang T. Comparison of clinical outcomes and complications of biportal and uniportal endoscopic decompression for the treatment of cervical spondylotic radiculopathy: A systematic review and meta-analysis. Jt Dis Relat Surg 2024;35(3):583-593. doi: 10.52312/jdrs.2024.1820.

Contributed to the conceptualization and design of the study, systematic literature search and data analysis, contributing significantly to the interpretation of the data: J.L., T.Z.; Was responsible for drafting the manuscript and performing the statistical review: J.L.; Provided a critical review of the manuscript and took primary responsibility for the final content: T.Z.; All authors reviewed and approved the final version of the manuscript.

The authors declared no conflicts of interest with respect to the authorship and/or publication of this article.

This study was supported by Sichuan Provincial Natural Science Foundation (2024NSFSC1619).

The data that support the findings of this study are available from the corresponding author upon reasonable request.