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Review
. 2025 Jun 26:21925682251356220.
doi: 10.1177/21925682251356220. Online ahead of print.

Comparison of the Biportal Endoscopic Versus Tubular Approach for the Treatment of Lumbar Degenerative Disease: A Systematic Review and Meta-Analysis

Mark Kurapatti  1 , Alexander Yu  1 , Hamza Ahmed  1 , Charu Jain  1 , Ryan Hoang  2 , Gray W Ricca  1 , Junho Song  1 , Daniel Berman  1 , Joshua Lee  1 , Samuel K Cho  1
Affiliations
Review

Comparison of the Biportal Endoscopic Versus Tubular Approach for the Treatment of Lumbar Degenerative Disease: A Systematic Review and Meta-Analysis

Mark Kurapatti et al. Global Spine J. .

Abstract

Study DesignSystematic Review and Meta-analysis.ObjectivesLumbar degenerative disease (LDD) is prevalent among aging adults. While tubular retraction is a widely used minimally invasive approach, biportal endoscopic spine surgery has emerged as a potential alternative. This systematic review and meta-analysis compares the clinical outcomes of tubular retraction and biportal endoscopy for decompression procedures (discectomy, laminectomy, laminotomy) and transforaminal lumbar interbody fusion (TLIF) in LDD patients.MethodsA systematic review and meta-analysis of comparative studies was conducted per PRISMA guidelines. A comprehensive search of PubMed, Embase, and Scopus identified relevant studies published before October 7, 2024. Data were analyzed using a random-effects model to assess Oswestry Disability Index (ODI), visual analog scale (VAS) scores for back and leg pain, complication rates, operative time, and length of stay at preoperative, ≤2-weeks postoperative, and ≥1-year postoperative time points.ResultsA total of 772 patients were included (400 tubular, 372 biportal). Biportal endoscopic surgery was associated with a lower complication rate (10.73% vs 15.94%; P < .001) and lower ≤2-week postoperative VAS back pain (2.70 ± 0.27 vs 3.55 ± 0.49; P < .001) relative to tubular spine surgery. Biportal decompression had a lower complication rate (15.13% vs 22.34%; P = .006) but similar patient-reported outcomes. Biportal TLIF had longer operative times (189.93 ± 25.90 vs 145.1 ± 14.90 min; P = .026) but lower complication rates (6.33% vs 9.55%; P = .026) and ≥1-year VAS leg pain (1.88 ± 0.29 vs 2.02 ± 0.26; P < .001).ConclusionsBiportal endoscopy for LDD had lower complication rates and similar patient-reported outcomes relative to tubular retraction, though longer operative times in TLIF subanalysis. Future studies are necessary to validate findings and guide patient-specific decision-making.

Keywords: biportal; endoscopy; lumbar spine; minimally invasive; tubular.

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Conflict of interest statement

The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Samuel K. Cho, MD, FAAOS, AAOS: Board or committee member, American Orthopaedic Association: Board or committee member, AOSpine North America: Board or committee member, Cervical Spine Research Society: Board or committee member, Globus Medical: IP royalties and Fellowship support, North American Spine Society: Board or committee member, Scoliosis Research Society: Board or committee member, Stryker: Paid consultant, The remaining authors have no conflicts of interest or sources of support that require acknowledgment.

Figures

Figure 1.
Figure 1.
PRISMA Flow Chart of the Study Selection Process
Figure 2.
Figure 2.
Forest Plot on the Effect of Tubular Retracted vs Biportal Endoscopic Spine Surgery on Complication Rate
Figure 3.
Figure 3.
Forest Plot on the Effect of Tubular Retracted vs Biportal Endoscopic Spine Surgery on ≤2-Week Visual Analogue Scale Back Pain
See this image and copyright information in PMC

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