Arthroscopic-assisted uni-portal spinal surgery versus unilateral biportal endoscopy for lumbar degenerative diseases: a systematic review and meta-analysis of clinical outcomes and complications
In brief
Uni-portal spine surgery cuts operating time by about 15 minutes
In a meta-analysis of three studies involving 810 patients, uni-portal surgery was associated with shorter operations, less blood loss and smaller incisions than biportal endoscopy. Back-pain scores and the rate of good or excellent outcomes also favored uni-portal surgery, but function, hospital stay and complications were similar; the small evidence base needs confirmation in high-quality trials.
- Journal
- BMC musculoskeletal disorders (Q2)
- Published
- 8 August 2026
- Study design
- Systematic review / meta-analysis of RCTs
- Evidence level
- Level 1, High (CEBM 1a)
- Authors
- Jianbo Yan, Lixin Deng, Donger Zeng, Bingyin Sun
- PMID
- 42983333
- DOI
- 10.1186/s12891-026-10328-8
Why clinicians should know about it
- Picked for Spine Surgery (top studies of the week, 8 November 2026): Meta-analysis compares endoscopic approaches for lumbar degenerative disease
Abstract
BACKGROUND: The optimal endoscopic surgical approach for lumbar degenerative diseases remains debated. This meta-analysis compared the clinical performance and safety of arthroscopic-assisted uni-portal spinal surgery (AUSS) versus unilateral biportal endoscopy (UBE/BESS). To provide guidance on the choice of surgical approaches of the lumbar degenerative diseases. METHODS: A systematic literature search was performed across PubMed, Embase, Web of Science, Cochrane Database, China National Knowledge Network, Wanfang Database, and China Biomedical Literature Database up to March 28, 2026. Studies comparing AUSS and UBE/BESS for lumbar degenerative conditions were included. We analyzed the extracted data with Review Manager 5.4. RESULTS: Three studies encompassing 810 patients (419 AUSS, 391 UBE/BESS) were analyzed. The AUSS group demonstrated significantly reduced operative time (MD = -14.72, 95% CI: -22.32 to - 7.12, P = 0.0001), lower intraoperative blood loss (MD =-10.59, 95% CI: -16.92 to - 4.26, P = 0.001), shorter incision length (MD = - 1.43, 95% CI: -1.64 to - 1.22, P < 0.00001), lower Visual Analog Scale (VAS) scores for back pain 3 months post-surgery (MD = -0.14, 95%CI: -0.24 to -0.03, P = 0.01), The excellent and good outcome rate was also higher in the AUSS group (OR = 1.52, 95%CI: 1.01 to 2.28, P = 0.04); No significant between-group differences emerged for hospital stay, Oswestry Disability Index (ODI) at any postoperative timepoint, or complication rates. CONCLUSIONS: Both techniques are safe and effective for lumbar degenerative diseases, with comparable functional recovery and safety profiles. AUSS appears to be associated with improved surgical efficiency, but these findings are exploratory and require confirmation by high-quality RCTs.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.