Biportal Endoscopic Spinal Surgery versus Microscopic Decompression for Lumbar Spinal Stenosis: A Systematic Review and Meta-Analysis

Abstract

Objective: Recent studies have shown that the clinical outcome in patients treated with the unilateral biportal endoscopic technique, also known as biportal endoscopic spinal surgery (BESS) unilateral laminotomy bilateral decompression (ULBD) in the context of this study, is more favorable compared with those treated with microscopic ULBD. In this systematic review and meta-analysis, we assess the latest evidence on the use of BESS ULBD compared with microscopic ULBD in patients with lumbar spinal stenosis.

Methods: We performed a systematic literature search of studies that compared BESS and microscopic ULBD from several databases.

Results: There were 383 patients from 5 unique studies. Meta-analysis of visual analog scale score for low back pain showed no significant difference at baseline (P = 0.49), at 2-3 months (P = 0.69), and at the final follow-up (P = 0.26). There was no significant difference in visual analog scale score for leg pain and Oswestry Disability Index between the groups preoperatively (P = 0.76 and P = 0.95), at 2-3 months (P = 0.46 and P = 0.92), and at the final follow-up (P = 0.88 and P = 0.58). The mean operation time was similar in the BESS and microsurgery groups (P = 0.36). The BESS group was associated with shorter length of stay (mean difference -2.60 days [-3.39, -1.81]; P < 0.001; I² = 65%). Complications were similar in both groups (P = 0.26). Individual studies have shown that BESS was associated with early ambulation and less need for opioids.

Conclusions: Current evidence shows a lack of significant differences in terms of efficacy and safety between BESS and microsurgery. Further studies are required before drawing a definite conclusion.

Keywords: Biportal endoscopic spinal surgery; Microscopic surgery; Spinal stenosis; Spine; Unilateral biportal endoscopic; Unilateral laminotomy bilateral decompression.