Introduction: Lumbar spinal stenosis (LSS) is a prevalent spinal degenerative disease. In recent years, both uniportal and biportal endoscopic decompression techniques have gained attention, demonstrating safety and promising clinical outcomes. However, there remains no consensus on the optimal endoscopic approach. This systematic review and updated meta-analysis aimed to evaluate the outcomes of both approaches for managing LSS.
Methods: Following PRISMA guidelines, we systematically searched PubMed, Embase, Cochrane Library, and Web of Science for randomized controlled trials and observational studies comparing uniportal and biportal decompression techniques for patients with LSS. Meta-analysis was performed using a random-effects model.
Results: Eight studies were included, comprising 927 patients, of whom 464 underwent uniportal and 463 biportal decompression. Operative time was significantly shorter in the biportal group (MD 21.77; 95% CI 6.73, 36.80; p< 0.01; I²=100%). However, no significant differences were found between groups in intraoperative blood loss (MD -2.66; 95% CI -9.18, 3.86; p=0.42; I²=99%), length of hospitalization (MD 0.02; 95% CI -0.23, 0.27; p=0.87; I²=43%), complication rate (OR 1.18; 95% CI 0.60, 2.72; p=0.527; I²=0%), and MacNab criteria excellent or good rate (OR 0.68; 95% CI 0.22, 2.14; p=0.511; I²=64%). Visual Analog Scale scores for back pain (MD 0.09; 95% CI -0.02, 0.20; p=0.10; I²=0%), leg pain (MD 0.11; 95% CI -0.18, 0.40; p=0.47; I²=70%), and Oswestry Disability Index (MD 0.78; 95% CI -0.11, 1.67; p=0.09; I²=0%) at the last follow-up did not differ significantly between groups.
Conclusion : This meta-analysis demonstrated that the biportal decompression had a significantly shorter operative time than the uniportal approach, with no significant differences between the two techniques in terms of intraoperative blood loss, length of hospitalization, complication rates, or patient outcomes related to pain and function. Further high-quality studies are needed to better assess the advantages of both approaches for LSS treatment.
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