Unilateral biportal endoscopic decompression compared with tubular or uniportal endoscopic decompression for lumbar spinal stenosis: a systematic review and meta-analysis

Background: Comparative evidence regarding unilateral biportal endoscopic decompression vs. tubular decompression or uniportal endoscopic decompression for lumbar spinal stenosis remains limited and inconsistent. Methods: We conducted a systematic review and meta-analysis of comparative clinical studies that evaluated UBE vs. tubular decompression or uniportal endoscopic decompression for lumbar spinal stenosis. Pooled analyses were performed for predefined outcomes, and comparator-specific analyses were additionally performed to improve interpretability. Results: A total of 1,395 patients from 10 studies were included in this meta-analysis. Overall complications and dural tear or cerebrospinal fluid leak events were lower in the unilateral biportal endoscopic decompression group than in the pooled control group. The unilateral biportal endoscopic decompression group also showed modestly lower ODI and pain scores at the final follow-up, although the magnitude of benefit varied across outcomes. In addition, the changes in the dural sac cross-sectional area after surgery also favored unilateral biportal endoscopic decompression, with low to moderate heterogeneity. Conclusions: For lumbar spinal stenosis, UBE may provide comparable overall safety and modest advantages in selected perioperative, clinical, and radiological outcomes compared with tubular or uniportal endoscopic decompression. However, the clinical relevance of some statistically significant differences remains uncertain, and further high-quality comparative studies are required.