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Review
. 2025 Sep;15(7):3517-3530.
doi: 10.1177/21925682251339999. Epub 2025 Apr 29.

Uniportal Versus Biportal Endoscopic Decompression for the Treatment of Lumbar Spinal Stenosis: A Systematic Review and Updated Meta-Analysis

Kaike Lobo  1 , Paweł Łajczak  2 , Numa Rajab  3 , Cláudia Santos  4 , Rafael Reis de Oliveira  5 , Yasmin P Silva  6 , Eshita Sharma  7 , Yan Gabriel M D Silva  8 , Ramon Guerra Barbosa  9
Affiliations
Review

Uniportal Versus Biportal Endoscopic Decompression for the Treatment of Lumbar Spinal Stenosis: A Systematic Review and Updated Meta-Analysis

Kaike Lobo et al. Global Spine J. 2025 Sep.

Abstract

Study DesignSystematic review and meta-analysis.ObjectiveAlthough uniportal and biportal endoscopic decompression have emerged as promising minimally invasive options for the management of lumbar spinal stenosis (LSS), their relative advantages remain debated. This systematic review and meta-analysis aims to evaluate the efficacy and safety of both approaches in LSS treatment.MethodsIn adherence to the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) guidelines, we systematically searched PubMed, Embase, Cochrane Library, and Web of science for randomized controlled trials and observational studies comparing the outcomes of uniportal and biportal endoscopic techniques for LSS treatment. Meta-analysis was performed using a random-effects model.ResultsA total of 11 studies were included, comprising 1199 patients. Biportal endoscopy was associated with a significantly lower operation time (P < .01), Oswestry Disability Index (ODI) at 12 months (P < .01), and higher postoperative dural sac area (P < .01) and dural sac area expansion (P = .02). There were no significant differences between groups in intraoperative blood loss, hospitalization time, back pain, leg pain, or ODI at other timepoints, ipsilateral facetectomy angle, and overall complications, including dural tear, infection, postoperative hematoma, lower limb numbness, and nerve root injury.ConclusionIn this meta-analysis, biportal endoscopic decompression demonstrated significantly lower operation time, ODI at 12 months, and higher postoperative dural sac area and dural sac area expansion, although both techniques showed similar safety profiles and complication rates. Further high-quality studies are needed to better assess the advantages of both techniques for LSS treatment.

Keywords: biportal endoscopy; lumbar spinal stenosis; meta-analysis; spine; systematic review; uniportal endoscopy.

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Conflict of interest statement

Declaration of Conflicting InterestThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Study selection flow diagram.
Figure 2.
Figure 2.
Forest plots comparing uniportal and biportal decompression in terms of operation time.
Figure 3.
Figure 3.
Forest plots comparing uniportal and biportal decompression in terms of intraoperative blood loss.
Figure 4.
Figure 4.
Forest plots comparing uniportal and biportal decompression in terms of length of hospital stay.
Figure 5.
Figure 5.
Forest plots comparing uniportal and biportal decompression in terms of Visual Analog Scale (VAS) for back pain at 3 days, 3 months, 6 months, and 12 months postoperatively.
Figure 6.
Figure 6.
Forest plots comparing uniportal and biportal decompression in terms of Visual Analog Scale (VAS) for leg pain at 3 days, 3 months, 6 months, and 12 months postoperatively.
Figure 7.
Figure 7.
Forest plots comparing uniportal and biportal decompression in terms of Oswestry Disability Index (ODI) at 3 months, 6 months, and 12 months postoperatively.
Figure 8.
Figure 8.
Forest plots comparing uniportal and biportal decompression in terms of MacNab criteria excellent or good rate.
Figure 9.
Figure 9.
Forest plots comparing uniportal and biportal decompression in terms of postoperative dural sac area, dural sac area expansion, and ipsilateral facetectomy angle.
Figure 10.
Figure 10.
Forest plots comparing uniportal and biportal decompression in terms of total complications, dural tear, and infection.
Figure 11.
Figure 11.
Forest plots comparing uniportal and biportal decompression in terms of postoperative hematoma, lower limb numbness, and nerve root injury.
See this image and copyright information in PMC

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