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Unilateral biportal endoscopic versus uniportal full-endoscopic for lumbar degenerative disease: A meta-analysis

  • Author Footnotes
    1 Co-first authors: Yanxing He and Hao Wang.
    Yanxing He
    Footnotes
    1 Co-first authors: Yanxing He and Hao Wang.
    Affiliations
    Department of Orthopedics, The Affiliated Changzhou No.2 People's Hospital with Nanjing Medical University, Changzhou, 213003, China

    Dalian Medical University, Liaoning, China
    Search for articles by this author
  • Author Footnotes
    1 Co-first authors: Yanxing He and Hao Wang.
    Hao Wang
    Footnotes
    1 Co-first authors: Yanxing He and Hao Wang.
    Affiliations
    Department of Orthopedics, The Affiliated Changzhou No.2 People's Hospital with Nanjing Medical University, Changzhou, 213003, China

    Dalian Medical University, Liaoning, China
    Search for articles by this author
  • Zhentang Yu
    Affiliations
    Department of Orthopedics, The Affiliated Changzhou No.2 People's Hospital with Nanjing Medical University, Changzhou, 213003, China

    Dalian Medical University, Liaoning, China
    Search for articles by this author
  • Jianjian Yin
    Correspondence
    Corresponding author. Department of Orthopedics, The Affiliated Changzhou No.2 People's Hospital with Nanjing Medical University, 29 Xinglong Lane, Tianning, Changzhou, 213003, China.
    Affiliations
    Department of Orthopedics, The Affiliated Changzhou No.2 People's Hospital with Nanjing Medical University, Changzhou, 213003, China
    Search for articles by this author
  • Yuqing Jiang
    Correspondence
    Corresponding author. Department of Orthopedics, The Affiliated Changzhou No.2 People's Hospital with Nanjing Medical University, 29 Xinglong Lane, Tianning, Changzhou, 213003, China.
    Affiliations
    Department of Orthopedics, The Affiliated Changzhou No.2 People's Hospital with Nanjing Medical University, Changzhou, 213003, China
    Search for articles by this author
  • Dong Zhou
    Affiliations
    Department of Orthopedics, The Affiliated Changzhou No.2 People's Hospital with Nanjing Medical University, Changzhou, 213003, China
    Search for articles by this author
  • Author Footnotes
    1 Co-first authors: Yanxing He and Hao Wang.
Published:November 24, 2022DOI:https://doi.org/10.1016/j.jos.2022.10.019

      Abstract

      Background

      Despite the increasing use of unilateral biportal endoscopic (UBE) and uniportal full-endoscopic (UPFE) techniques in lumbar degenerative disease (LDD), few comprehensive and systematic studies have been published comparing UBE and UPFE. Therefore, we conducted a meta-analysis to compare the surgical outcomes of the two procedures.

      Methods

      We searched all studies that compared operative outcomes of UBE and UPFE for lumbar disc degeneration disease from PubMed, Google Scholar, Web of Science, Chinese Biomedical Literature Database, China National Knowledge Infrastructure (CNKI), Wanfang and other databases up to March 30, 2022.

      Results

      This meta-analysis, which included nine articles, showed that in operative time, (mean difference [MD]: 17.14; 95% confidence intervals [CI]: 6.52 to 27.76), intraoperative bleeding (MD: 59.01; 95% CI: 21.29 to 96.73) and hospital stay (MD: 2.12; 95% CI: 0.35 to 3.90), the UPFE group was more advantageous. UBE had an advantage in terms of postoperative dural expansion area (MD: 59.01; 95% CI: 21.29 to 96.73). These aspects included postoperative clinical score (MD: 0.48; 95% CI: -0.27 to 1.24; MD: -0.07; 95% CI: -0.30 to 0.16; MD: 0.09; 95% CI: -0.09 to 0.26; MD: 0.11; 95% CI: -0.04 to 0.26; MD: -0.81; 95% CI: -3.03 to 1.41; MD: -0.38; 95% CI: -1.02 to 0.26), excellent and good rate (odds ratio [OR] = 1.08; 95% CI: 0.34 to 3.44), complications (OR = 0.82; 95% CI: 0.31 to 2.12), postoperative hospital stay (MD: 1.63; 95% CI: -0.81 to 4.07) and mean number of fluoroscopies (MD: -7.18; 95% CI: -22.84 to 8.48), with no significant difference between the two groups. Meanwhile, the lumbar disc herniation (LDH) subgroup of UPFE had a significantly shorter operation time (MD: 31.67; 95% CI: 12.44 to 50.90) than that of UBE.

      Conclusion

      Our study showed that UPFE was associated with shorter operative time, less intraoperative bleeding and shorter hospital stay, whereas UBE was associated with a greater increase in postoperative dural sac area. Postoperative visual analog scale (VAS) scores, Oswestry Disability Index (ODI) scores, satisfaction rates, complications, and mean number of fluoroscopic views were not dramatically dissimilar in UBE and UPFE for LDD. In the LDH subgroup, postoperative hospital stay and operative time were significantly lower in the UPFE group than in the UBE group.

      Keywords

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