Complications in Cervical Minimally Invasive Spine Surgery: A Proportional Meta-analysis of Tubular, Uniportal, and Biportal Approaches

Introduction: Minimally invasive spine surgery (MISS) for cervical pathologies has demonstrated superior clinical outcomes compared to the open approaches, but differences in complication rates among the tubular, uniportal, and biportal techniques remain unclear. This proportional meta-analysis compares complication rates across these techniques utilizing studies published in the last decade.

Methods: Following PRISMA guidelines, we conducted a systematic review and meta-analysis (PROSPERO CRD42024594335). PubMed, Medline, Embase, and Cochrane Library were queried for cervical MISS studies (Jan 2013-Mar 2024) utilizing tubular, uniportal, or biportal approaches. Included studies reported complication rates in adult cohorts. Exclusions were abstracts, reviews, and non-English articles. A random-effects model was applied, and the I² statistic assessed heterogeneity. All analyses were conducted using R Studio.

Results: Twenty-one studies (1299 patients) were included, with average patient ages ranging from 47 to 74.5 years and 64% male. All studies had low bias risk. Follow-up periods ranged from 3 to 33 months. The pooled complication rate for cervical MISS was 5% (95% CI [3%-7%]), with heterogeneity (I²=59%). Subgroup analysis showed complication rates of 4% (95% CI [1%-10%], I² = 70%) for tubular, 6% (95% CI [2% -12%], I2 = 46%) for uniportal, and 5% (95% CI [2%-8%], I2 = 39%) for biportal. No statistically significant differences were found (P=0.85). Nerve injury rates were higher with the uniportal approach (6%, 95% CI [2%-16%], P = 0.02). Dural tears (1%, 95% CI [0%-2%], I² = 0%) and postoperative hematomas (0%, 95% CI [0%-3%], I² = 0%) had low incidence, with no significant differences between approaches (P = 0.61 and P = 0.78, respectively).

Conclusion : Cervical MISS demonstrates a low overall complication rate, with tubular approaches showing a numerically lower risk, though differences were not statistically significant. Larger comparative studies are needed to provide more definitive results for better clinical application.