Efficacy and Safety of Unilateral Biportal Endoscopy Compared to Microscopic and Uniportal Approaches in Lumbar Spinal Stenosis: evidence from 25 studies

Resumo

Introdução: A estenose lombar (LSS) é uma condição degenerativa comum em idosos, frequentemente exigindo descompressão cirúrgica. Abordagens minimamente invasivas endoscópicas têm recebido atenção pelo potencial de reduzir o dano aos tecidos moles e melhorar a recuperação. Métodos: Foram incluídos estudos comparativos: UBE, endoscopia uniportal e descompressão microscópica para o tratamento da estenose lombar. Os desfechos de melhora clínica e complicações foram analisados. Resultados: Foram incluídos 25 estudos, totalizando 3.496 pacientes. A UBE apresentou melhora significativamente maior no ODI (p = 0,00001), menor perda sanguínea intraoperatória e menor tempo de internação. A satisfação dos pacientes também foi maior no grupo UBE em relação à cirurgia microscópica (p = 0,004). Quando comparada à endoscopia uniportal, a UBE apresentou resultados semelhantes em ODI, EVA, tempo cirúrgico e satisfação. Conclusões: A UBE proporciona resultados clínicos semelhantes ou superiores à endoscopia uniportal e à descompressão microscópica em termos de melhora funcional, mantendo perfil de segurança equivalente. Contudo, considerando a relativa novidade da UBE e a concentração de estudos favoráveis em centros de alto volume, deve-se ponderar a possibilidade de viés de publicação e comercial.

Palavras-chave

Estenose lombar; Endoscopia biportal unilateral; Cirurgia endoscópica da coluna; Descompressão microscópica;

Abstract

Background: Lumbar spinal stenosis (LSS) is a prevalent degenerative disorder in the elderly, frequently necessitating surgical decompression. Microscopic decompression has long been established, but minimally invasive approaches, including monoportal and unilateral biportal endoscopy (UBE), are increasingly utilized for their potential to limit tissue damage and enhance recovery. This systematic review and meta-analysis compared the efficacy and safety of UBE with monoportal and microscopic techniques. Methods: Eligible studies compared at least two techniques — UBE, monoportal endoscopy, or microscopic decompression — for LSS. Outcomes assessed included Oswestry Disability Index (ODI), Visual Analog Scale (VAS) for pain, intraoperative blood loss, operative time, hospital stay, patient satisfaction, reoperation rates, and complications (dural tears, infections, hematomas, neural injury). Protocol: PROSPERO (CRD420251079604). Results: Twenty-five studies with 3,496 patients were included. Compared with microscopic surgery, UBE yielded greater ODI improvement (p = 0.00001), less blood loss, shorter hospital stays, and higher satisfaction (p = 0.004). Versus monoportal endoscopy, UBE showed similar ODI, VAS, operative time, and satisfaction, but greater blood loss and slightly longer hospitalization. Conclusions: UBE provides outcomes equal to or superior to monoportal and microscopic decompression with comparable safety. Nonetheless, evidence may reflect publication or institutional bias, highlighting the need for high-quality randomized trials with transparent conflict-of-interest reporting.

Keywords

Lumbar spinal stenosis; Unilateral biportal endoscopy; Endoscopic spine surgery; Microscopic decompression; Minimally invasive spine surgery; Systematic review

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