Comparison of efficacy and safety between unilateral biportal endoscopy and percutaneous endoscopic surgery for cervical spondylotic radiculopathy based on current evidence: a systematic review and meta-analysis

A systematic comparison of the clinical efficacy and safety between Unilateral Biportal Endoscopy (UBE) and Percutaneous Endoscopy (PE) in the Treatment of Cervical Spondylotic Radiculopathy (CSR). Computerized searches were conducted in PubMed, Cochrane Library, Web of Science, Embase, China National Knowledge Infrastructure(CNKI), Wanfang Data, VIP Chinese Science and Technology Periodical Database(VIP) and other relevant journals to collect clinical studies comparing UBE and PE for the treatment of CSR, from the inception of each database until September 2025. Two researchers independently performed literature screening and data extraction, and assessed the quality of the included studies using the Newcastle-Ottawa Scale (NOS). Meta-analysis was carried out with RevMan 5.4 software on the following outcomes: operative time, intraoperative blood loss, visual analog scale (VAS) scores for neck and upper limb pain, Neck Disability Index (NDI), MacNab excellent-good rate, and complications. The search strategy flowchart follows the PRISMA 2020 flow diagram. A total of 6 studies were ultimately included, comprising 222 patients in the UBE group and 205 patients in the PE group. Meta-analysis results demonstrated that, compared to the PE group, the UBE group had a shorter operative time [MD = -13.72, 95% CI (-15.80, -11.64), P < 0.00001], but a greater amount of intraoperative blood loss [MD = 17.09, 95% CI (2.59, 31.58), P = 0.02]. Regarding pain and functional recovery, the UBE group showed superior upper limb VAS scores at the 3-month postoperative follow-up [MD = -0.14, 95% CI (-0.26, -0.01), P = 0.03] compared to the PE group. However, there were no statistically significant differences between the two groups in VAS scores at the remaining time points (postoperative 3 days, 1, 6, and 12 months), NDI scores at all time points, the MacNab excellent-good rate, or the overall complication rate. Both UBE and PE are safe and effective minimally invasive techniques for treating CSR, with comparable long-term outcomes. UBE has a shorter operative time but relatively greater intraoperative blood loss. At the 3-month postoperative upper limb VAS assessment, the UBE group demonstrated a statistical advantage, though the clinical significance of this difference requires further evaluation. Surgical selection should be individualized based on specific pathological characteristics, patient factors, and surgeon expertise.