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. 2023 Jan 10:13:1089981.
doi: 10.3389/fneur.2022.1089981. eCollection 2022.

Unilateral biportal endoscopic lumbar interbody fusion enhanced the recovery of patients with the lumbar degenerative disease compared with the conventional posterior procedures: A systematic review and meta-analysis

Honghao Yang  1 , Fengqi Cheng  1 , Yong Hai  1 , Yuzeng Liu  1 , Aixing Pan  1
Affiliations

Unilateral biportal endoscopic lumbar interbody fusion enhanced the recovery of patients with the lumbar degenerative disease compared with the conventional posterior procedures: A systematic review and meta-analysis

Honghao Yang et al. Front Neurol. .

Abstract

Background: Minimally invasive endoscopic technique is an important component of Enhanced Recovery After Surgery (ERAS) protocol for neurosurgery. In recent years, unilateral biportal endoscopic lumbar interbody fusion (ULIF) has been used in the treatment of lumbar degenerative diseases (LDD). This study aims to investigate whether ULIF could enhance the recovery of patients with LDD compared with the conventional minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) or posterior lumbar interbody fusion (PLIF).

Methods: A comprehensive literature search was performed for relevant studies in PubMed, EMBASE, Web of Science, Cochrane Library database, China National Knowledge Internet, and Wanfang database. Surgical data, clinical outcomes, radiographic outcomes, and surgical complications were compared between patients with LDD who underwent ULIF and those who underwent conventional MI-TLIF or PLIF.

Results: Notably, 12 studies, comprising 981 patients with LDD, were included. Of these patients, 449 underwent ULIF and 532 patients (355 MI-TLIF and 177 PLIF) were treated with conventional procedures. There was no significant difference in the fusion rate, cage subsidence rate, and surgical complications between the ULIF group and the MI-TLIF or PLIF group. Compared with MI-TLIF, the ULIF group presented a significantly reduced estimated blood loss (EBL) (WMD, -106.00; 95% CI -140.99 to -71.10, P < 0.001) and shorter length of hospital stay (LOS) (WMD, -1.27; 95% CI -1.88 to -0.66, P < 0.001); better short-term improvement in ODI (WMD, -2.12; 95% CI -3.53 to -0.72, P = 0.003) and VAS score for back pain (VAS-BP) (WMD, -0.86; 95% CI -1.15 to -0.58, P < 0.001) at 1 month post-operatively. Compared with PLIF, the ULIF group presented a significantly reduced EBL (WMD, -149.22; 95% CI -284.98 to -13.47, P = 0.031) and shorter LOS (WMD, -4.40; 95% CI -8.04 to -0.75, P = 0.018); better short-term improvement in VAS-BP (WMD, -1.07; 95% CI -1.77 to -0.38, P = 0.002) and VAS score for leg pain (VAS-LP) (WMD, -0.40; 95% CI -0.72 to -0.08, P = 0.014) at 1-2 week post-operatively; enhanced short- and long-term improvement in ODI at 1 month post-operatively (WMD, -3.12; 95% CI -5.72 to -0.53, P = 0.018) and the final follow-up (WMD, -1.97; 95% CI -3.32 to -0.62, P = 0.004), respectively.

Conclusion: Compared with conventional MI-TLIF and PLIF, ULIF was associated with reduced EBL, shorter LOS, and comparable fusion rate as well as complication management. Compared with MI-TLIF, a better short-term improvement in VAS-BP and ODI was achieved by ULIF; compared with open PLIF, additional enhanced short-term improvement in VAS-LP and long-term improvement in ODI were observed in ULIF. ULIF could enhance the recovery of patients with LDD compared with conventional posterior procedures.

Systematic trial registration: https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=230695, CRD42021230695.

Keywords: Enhanced Recovery After Surgery; lumbar degenerative disease; minimally-invasive transforaminal lumbar interbody fusion; neurosurgery; posterior lumbar interbody fusion; unilateral biportal endoscopic lumbar interbody fusion.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Flow diagram depicting the literature review, search strategy, and selection process.
Figure 2
Figure 2
Forest plot of the estimated blood loss. (A) ULIF vs. MI-TLIF; (B) ULIF vs. PLIF.
Figure 3
Figure 3
Forest plot of the operating time. (A) ULIF vs. MI-TLIF; (B) ULIF vs. PLIF.
Figure 4
Figure 4
Forest plot of the length of hospital stay. (A) ULIF vs. MI-TLIF; (B) ULIF vs. PLIF.
Figure 5
Figure 5
Forest plot of the post-operative drainage. (A) ULIF vs. MI-TLIF; (B) ULIF vs. PLIF.
Figure 6
Figure 6
Forest plot of the Oswestry Disability Index at the final follow-up. (A) ULIF vs. MI-TLIF; (B) ULIF vs. PLIF.
Figure 7
Figure 7
Forest plot of the Visual Analog Scale score for back pain at the final follow-up. (A) ULIF vs. MI-TLIF; (B) ULIF vs. PLIF.
Figure 8
Figure 8
Forest plot of the Visual Analog Scale score for leg pain at the final follow-up. (A) ULIF vs. MI-TLIF; (B) ULIF vs. PLIF.
Figure 9
Figure 9
Forest plot of the fusion rate. (A) ULIF vs. MI-TLIF; (B) ULIF vs. PLIF.
Figure 10
Figure 10
Forest plot of the overall surgical complication rate. (A) ULIF vs. MI-TLIF; (B) ULIF vs. PLIF.
Figure 11
Figure 11
Forest plot of the incidence of dural tear. (A) ULIF vs. MI-TLIF; (B) ULIF vs. PLIF.
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