Efficacy and safety of unilateral biportal endoscopic discectomy and conventional endoscopic discectomy in the treatment of lumbar disc herniation: a systematic review and meta-analysis

Abstract

Background: Unilateral double-port endoscopic (UBE) discectomy is a newly invented surgical procedure for the treatment of lumbar disc herniation (LDH). As it has been on the market for a relatively short period of time, the lack of systematic analysis of the clinical efficacy and safety of the treatment of LDH is unclear.In this study, we compare randomised controlled trials to assess the clinical efficacy and safety of UBE and conventional endoscopic discectomy for LDH. Methods:The Chinese National Knowledge Infrastructure, Wanfang, PubMed, Embase, Cochrane library, and Chinese Biomedical databases were searched (from database inception to October 2022). The quality of included studies was assessed according to the Cochrane Risk Manual. The intervention of the UBE group was UBE discectomy, and the control measure was conventional endoscopic discectomy. The outcome indicators included hospital stay, the visual analogue score (VAS), intraoperative bleeding, the Oswestry dysfunction index (ODI), and complications. The data were analyzed using RevMan 5.4. Results:In total, 7 studies were included. Intraoperative bleeding was higher in the control group than in the UBE group (MD =−0.07; 95% confidence interval (CI): −0.21 to 0.08; P=0.14). The improvement of ODI score in the UBE group was significantly better (MD =0.13, 95% CI: −0.06 to 0.32; P=0.17). There was no statistical heterogeneity in terms of postoperative complications (I 2 =0%, P=1.00). The complication rate in the UBE group was lower (MD =0; 95% CI: −0.15 to 0.15; P=1.00). Postoperative VAS improvement in UBE group was significantly better (MD =−0.12; 95% CI: −0.27 to 0.03; P=0.11). The length of hospital stay in UBE group was shorter (MD =−2.04; 95% CI: −2.23 to −1.84; P<0.05). The t value of hospitalization length, VAS, Intraoperative bleeding, ODI and complicationswere 0.000-0.081, v was 20-26, all P>0.05, suggesting that this conclusion was stable.Conclusions: Patients in the UBE group spent less time in the hospital than the control group, and UBE group patients also woke up earlier than the control group. Therefore, UBE discectomy has certain reference value and can be popularized in clinic.

Case Report: Bacterial meningitis due to cerebrospinal fluid leakage following unilateral biportal endoscopic spinal surgery: a cautionary tale

“…Dural tears during unilateral biportal endoscopic (UBE) surgery primarily result from a lack of familiarity with the technique in the early stages of adoption, coupled with the potential for inadvertent injury to the dura during the manipulation of the yellow ligament and removal of the ligamentum flavum. To prevent such injuries, it is crucial for the surgeon to exercise care when separating the dura from the ligamentum flavum while removing it along the path of the nerve root ( 9 ).…”