Comparison of biportal versus uniportal endoscopic decompression for the treatment of lumbar degenerative disease: a systematic review and meta‑analysis

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Abstract
Systematic review and meta-analysis. To perform a comprehensive meta-analysis comparing clinical outcomes of uniportal versus biportal endoscopic spine surgery across decompression procedures in patients with lumbar degenerative disease (LDD). Uniportal endoscopic spine surgery has been a widely adopted minimally invasive technique, whereas biportal endoscopy has recently emerged as a promising alternative with potential advantages in surgical outcomes. A systematic review and meta-analysis of comparative studies was conducted in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. PubMed, Embase, and Scopus databases were searched to identify relevant studies. Eleven studies encompassing 374 uniportal and 368 biportal patients were included. Outcomes analyzed were Oswestry Disability Index (ODI), Visual Analog Scale (VAS) scores for back and leg pain, complication rates, operative time, and length of hospital stay. Biportal endoscopic surgery was associated with a significantly lower ODI at 1-3 months and at final follow-up compared with uniportal surgery. However, uniportal discectomy demonstrated significantly shorter operative time and length of hospital stay than biportal discectomy. No significant differences were observed between approaches in terms of VAS scores, complication rates, or ODI at other time points. Both uniportal and biportal endoscopic spine surgeries yield comparable postoperative outcomes in LDD. Although biportal surgery showed a modest advantage in ODI improvement, it did not reach the minimal clinically important difference. Uniportal surgery demonstrated greater efficiency in terms of operative time and recovery, particularly for discectomy procedures.

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