Zhongguo linchuang yanjiu (May 2024)
Efficacy of unilateral biportal endoscopy versus unilateral endoscopiy in the treatment of lumbar degenerative diseases: a Meta-analysis
Abstract
Objective Meta-analysis was used to compare the efficacy of unilateral biportal endoscopy (UBE) and unilateral endoscopy(UE) in the treatment of lumbar degenerative diseases (LDD), in order to provide a reference for clinical treatment selection. Methods By searching the literature on UBE or UE treatment of LDD in PubMed, Web of Science, Wanfang database, CNKI and other databases, with searching date from March 2019 to November 2023. The quality of the collected literature was evaluated and the relevant outcome data were extracted, then Meta-analysis was conducted. The outcome indicators included: operative time, intraoperative blood loss, postoperative hospital stay, complication rate, number of intraoperative fluoroscopies, modified MacNab grading scale, visual analogue scale (VAS) for low back pain or leg pain, and Oswestry disability index (ODI). Results Sixteen papers (including 2 randomized controlled studies, 14 non-randomized controlled studies) with a total of 1 398 patients (including 709 patients treated with UBE , 689 patients treated with UE) were finally enrolled. The results of the Meta-analysis:compared with UE, the number of intraoperative fluoroscopy was higher in UBE ［MD=0.16,95%CI(0.05,0.26),P=0.004］; the VAS score of back and leg pain and ODI in the early postoperative period were better［MD=-0.20,95%CI(-0.34,-0.07),P=0.004; MD=-0.17,95%CI(-0.33,-0.01),P=0.03;MD=-0.72,95%CI(-1.36,-0.08),P=0.03］. Subgroup analysis: for LSS,the operation time of UBE was shorter than that of UE［MD=-10.28,95%CI(-16.74,-3.82),P＜0.01;the VAS score of postoperative back pain was better［MD=-0.22,95%CI(-0.42,-0.01),P=0.04］. For LDH,the operation time of UBE was longer than that of UE［MD=14.45,95%CI(4.07,24.84),P<0.01］; intraoperative blood loss was higher［MD=29.40,95%CI(12.52,46.28),P＜0.01］;however, postoperative ODI was better［MD=-0.84,95%CI(-1.39,-0.29),P＜0.01］. Conclusion The results demonstrate that for LSS, UBE has the potential to reduce operative time. While for LDH, UE still has the advantages of less trauma, shorter operative time, and less blood loss. and in addition, UBE may have the potential to alleviate early postoperative low back pain and leg pain.
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