Comparison of Biportal and Uniportal Spine Endoscopy for Effectiveness and Perioperative Safety: A Systematic Review and Meta-Analysis

This study aimed to evaluate clinical effectiveness, surgical metrics (operative time and blood loss), postoperative recovery (hospital stay), patient-reported success (MacNab criteria), and complications between uniportal and biportal endoscopic spine surgery in patients with lumbar degenerative disease. The systematic review and meta-analysis implemented Preferred Reporting Items for Systematic Reviews and Meta-Analyses and Cochrane guidelines for its methodology. The search of multiple databases during the last 20 years resulted in 53 studies that met the criteria for comparing biportal and uniportal endoscopic surgery approaches. The research team conducted data extraction and quality assessment, followed by random-effects proportion-based meta-analysis to present findings through tables and forest plots and risk-of-bias analysis. Heterogeneity was assessed using the I² statistic and τ² estimates. The MacNab scores from the pooled analysis revealed no substantial difference between uniportal and biportal groups (pooled log odds ratio = -0.243, 95% CI = -1.02 to 0.53, p = 0.62), which demonstrated similar patient satisfaction and functional recovery between the two groups. Complication rates were also similar between the two approaches, with low heterogeneity across studies. The random-effects model for Visual Analog Scale leg pain in biportal surgery showed a significant decrease (intercept = 5.36, τ² = 5.40, I² = 98.3%, p < 0.001), which indicates that there was considerable variation and a general improvement in pain results. Risk-of-bias evaluation showed that most studies had low to moderate risk, while missing outcome data and outcome measurement domains had the lowest bias levels. The two approaches of uniportal and biportal endoscopy deliver equal effectiveness and safety when performing lumbar spine decompression surgery. The biportal technique delivers superior postoperative pain management, but research indicates no major distinction in treatment results. Given the generally low to moderate risk of bias and consistency across studies, these findings support the use of either technique based on surgeon expertise and patient preference.