A Systematic Review of Unilateral Biportal Endoscopic Spinal Surgery: Preliminary Clinical Results and Complications

Abstract

Objective: Unilateral biportal endoscopic spine surgery (UBE) for the treatment of lumbar spinal diseases has achieved favorable results. In this systematic review, the technical nuances, surgical outcomes, and complications of UBE are summarized.

Methods: A systematic review of the literature published to June 2018 was performed. Reported studies related to UBE were identified through searching the PubMed database. The outcomes measured included operative time, hospital stay, complications, visual analog scale (VAS), Oswestry Disability Index, and the Macnab criteria.

Results: A total of 556 patients and 679 levels were collected from the selected 11 studies. The mean follow-up was 15.2 months, the mean operative time was 81.3 minutes, and the mean length of hospital stay was 4.4 days. The mean overall complication rate was 6.7% (range, 0%-13.8%). The mean VAS score for leg pain decreased from preoperative 7.9 to 1.9 at final follow-up visit and the mean VAS score for back pain decreased from 5.7 to 1.8. The mean Oswestry Disability Index significantly improved from preoperative 63.7 to 18.6 at the final follow-up. The average satisfied outcome (excellent/good; based on the Macnab criteria) was 84.3% (range, 75.35%-95%). There were similar results between UBE for the treatment of lumbar disc herniation and stenosis, including operative time, length of hospital stay, complications, and satisfaction rate.

Conclusions: Although the existing studies are limited to small cohorts and short-term follow-up, based on the given preliminary results and experiences of current studies, UBE may be a feasible option for lumbar spinal surgery.

Keywords: Biportal; Endoscopic spine decompression; Endoscopic spine discectomy; Endoscopic spine laminectomy; Spinal endoscopy.