Clinical efficacy and safety of arthroscopic-assisted uni-portal spinal surgery in the treatment of single-level lumbar degenerative disease: a systematic review and meta-analysis

Abstract Objective This systematic review and meta-analysis aimed to evaluate the clinical efficacy and safety of arthroscopic-assisted uni-portal spinal surgery (AUSS/UNSES) in treating single-level lumbar degenerative disease (LDD). Methods A comprehensive literature search was conducted across multiple databases up to August 20, 2026, following PRISMA 2020 guidelines. Studies investigating AUSS/UNSES for single-level LDD were included. Data on VAS, ODI, complication rates, MacNab excellent-good rate, perioperative parameters, and dural sac CSA were extracted and pooled using random- or fixed-effects models. Quality was assessed using the Newcastle-Ottawa Scale and RoB 2.0. Results Eleven studies involving 773 patients were included. The pooled complication rate was 3.6% (95% CI: 2.3%–5.4%), and the MacNab excellent-good rate was 89.6% (95% CI: 87.0%–91.8%). Significant functional improvements were observed: ΔODI at 3, 6, and 12 months was 43.96%, 51.60%, and 40.64%, respectively; lumbar VAS decreased by 3.81 points and leg VAS by 4.88 points. Mean operative time was 67.30 min, blood loss 54.12 mL, hospital stay 4.47 days, and incision length 1.65 cm. Dural sac CSA increased by 69.19 mm 2 postoperatively. Subgroup analysis (LSS vs. LDH) showed significant differences in functional and perioperative outcomes ( P < 0.05), while safety outcomes were comparable ( P > 0.05). Most outcomes showed high heterogeneity, but sensitivity analyses confirmed robustness. Conclusions AUSS/UNSES demonstrates promising clinical efficacy and safety for single-level lumbar degenerative disease, with significant advantages in pain relief, functional improvement, and reduced surgical trauma. These findings are limited by the predominance of retrospective, single-arm studies.