Clinical Efficacy and Complications of Spinal Surgery Unilateral Biportal Endoscopy for Cervical Spondylosis: A Systematic Review and Meta-Analysis

Objective

This systematic review and meta-analysis evaluated the clinical efficacy and complications of unilateral biportal endoscopy (UBE) for treating cervical spondylosis (CS), providing evidence-based guidance for optimal treatment decisions.

Methods

Relevant studies on UBE for CS were identified through comprehensive searches of PubMed, Embase, Web of Science, and the Cochrane Library up to April 22, 2024. Studies included patients diagnosed with CS who underwent UBE surgery and reported outcomes such as visual analog scale (VAS) scores, neck disability index scores, and postoperative complications. Data extraction and quality assessment were performed independently by 2 reviewers. Statistical analyses were conducted using Stata 15, employing random-effects models due to significant heterogeneity (I² > 50%).

Results

Nine publications, comprising 353 patients and 400 operation levels, met the inclusion criteria. The mean follow-up duration was 17.01 months, and the operative time for a single level was 71.29 minutes. The average VAS score for neck pain decreased from 6.08 preoperatively to 1.52 postoperatively, the average VAS score for arm pain decreased from 7.13 to 1.35, and the average neck disability index decreased from 34.61 to 6.83 at the final follow-up. The mean satisfaction rate (good or excellent using the Macnab criteria) was 91%. The overall complication rate was 5%, with the most frequent complication being a dural tear (1%), followed by nerve root injury or transient hypoesthesia (0.3%).

Conclusions

UBE demonstrates strong efficacy and safety in treating CS, with significant improvements in pain and disability scores, shorter operative times, and lower complication rates.