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Meta-Analysis
. 2022 Sep 21:2022:7667463.
doi: 10.1155/2022/7667463. eCollection 2022.

Unilateral Biportal Endoscopic Discectomy versus Microendoscopic Discectomy for the Treatment of Lumbar Spinal Stenosis: A Systematic Review and Meta-Analysis

Yufei Niu  1 , Zhen Shen  1 , Haoyang Li  1
Affiliations
Meta-Analysis

Unilateral Biportal Endoscopic Discectomy versus Microendoscopic Discectomy for the Treatment of Lumbar Spinal Stenosis: A Systematic Review and Meta-Analysis

Yufei Niu et al. Comput Math Methods Med. .

Abstract

Objective: In minimally invasive spinal surgery, the treatment of lumbar spinal stenosis with microendoscopic discectomy (MED) or unilateral biportal endoscopic discectomy (UBED) shows effective results, but which is more effective is controversial. Our study aimed to evaluate the efficacy and safety of UBED versus MED in the treatment of lumbar spinal stenosis by a systematic review and meta-analysis, so as to provide reference for the promotion of UBED in clinical practice.

Methods: The multiple databases like PubMed, EMBASE, Web of Science, Cochrane Library, Chinese National Knowledge Databases, Chinese BioMedical Database, and Wanfang Database were used to search for the relevant studies. Review Manager 5.4 was adopted to estimate the effects of the results among selected articles. Odds ratio (OR) and mean difference (MD) with 95% confidence intervals (CIs) were used to estimate the overall pooled effect. Subgroup analysis, forest plots, funnel plots and Egger's test for the articles included were also conducted.

Results: Three randomized clinical trials and seven cohort studies were finally retrieved, these studies included 685 and 829 patients in the UBED and MED groups, respectively. There were no differences in terms of operation time (MD = -0.92, P =0.72), estimated blood loss (MD = -26.31, P =0.08), complications (MD =0.81, P =0.38) and Oswestry Disability Index (ODI) score (P >0.05 in four subgroup) between the two groups. The visual analog scale (VAS) score of back pain in the UBED group was better than MED group only at 6 months (MD = -0.23, P =0.006) after operation, the VAS score of leg pain in the UBED group was better than that of MED group at 3 mouths (MD = -0.22, P =0.002) and 6 months (MD = -0.24, P =0.006) after operation, the UBED group had a less postoperative length of stay than the MED group (MD = -1.85, P <0.001). The bias analysis showed that there was no potential publication bias in the included literature.

Conclusion: This study showed that compared with MED, UBED has the advantages of short hospital stay and good short-term curative effect, but there is no significant difference in long-term efficacy and safety, they can be replaced by each other in clinical application.

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Conflict of interest statement

The author(s) declare(s) that they have no conflicts of interest.

Figures

Figure 1
Figure 1
Schematic of the trial selection process.
Figure 2
Figure 2
Forest plots of patient clinical outcomes: VAS of back pain. VAS, visual analog scale. UBED, unilateral biportal endoscopic discectomy; MED, microendoscopic discectomy.
Figure 3
Figure 3
Forest plots of patient clinical outcomes: VAS of leg pain. VAS, visual analog scale. UBED, unilateral biportal endoscopic discectomy; MED, microendoscopic discectomy.
Figure 4
Figure 4
Forest plots of patient clinical outcomes: ODI. ODI, Oswestry Disability Index. UBED, unilateral biportal endoscopic discectomy; MED, microendoscopic discectomy.
Figure 5
Figure 5
Forest plots of patient clinical outcomes: operation time. UBED, unilateral biportal endoscopic discectomy; MED, microendoscopic discectomy.
Figure 6
Figure 6
Forest plots of patient clinical outcomes: postoperative length of stay. UBED, unilateral biportal endoscopic discectomy; MED, microendoscopic discectomy.
Figure 7
Figure 7
Forest plots of patient clinical outcomes: estimated blood loss.
Figure 8
Figure 8
Forest plots of patient clinical outcomes: complication. UBED, unilateral biportal endoscopic discectomy; MED, microendoscopic discectomy.
Figure 9
Figure 9
Funnel plot for potential publication bias of complication.
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