Short-Term Postoperative Pain and Function of Unilateral Biportal Endoscopic Discectomy versus Percutaneous Endoscopic Lumbar Discectomy for Single-Segment Lumbar Disc Herniation: A Systematic Review and Meta-analysis

Abstract

Objective. Spinal surgery is gradually moving toward minimally invasive surgery, but there is still some lack of knowledge about the Unilateral Biportal Endoscopic (UBE) technique that has been hotly debated in recent years. We performed this systematic review and meta-analysis to clarify whether UBE is superior to percutaneous endoscopic lumbar discectomy (PELD) for relieving short-term postoperative pain and promoting functional recovery. Methods. Computer searches of PubMed, Embase, Cochrane Library, Web of Science, CNKI, and Wanfang databases were performed to search for studies on UBE versus PELD for single-segment lumbar disc herniation (ssLDH) from the time of database construction to Mar. 2022, and two investigators independently performed literature screening and data extraction, and evaluation of the quality of the included studies was observed as operation time, complications, and visual analogue scale (VAS) at each preoperative and postoperative stage as well as Oswestry Disability Index (ODI), and meta-analysis was performed by applying the Review Manager 5.4 software. Results. Meta-analysis showed that PELD had shorter operation time ( $\text{MD}=35.36$ , 95% CI (4.67, 66.04), $P=0.02$ ) and had lower VAS of back pain at 3 days postoperatively ( $\text{MD}=0.62$ , 95% CI (0.04, 1.19), $P=0.04$ ) compared to the UBE. However, there was no statistical significance between the two groups in terms of complications ( $\text{MD}=2.53$ , 95% CI (0.40, 16.11), $P=0.33$ ), VAS of back pain at 30 days postoperatively ( $\text{MD}=0.05$ , 95% CI (-0.19, 0.28), $P=0.70$ ), VAS of leg pain at 3 days postoperatively ( $\text{MD}=0.21$ , 95% CI (-0.20, 0.61), $P=0.33$ ), VAS of leg pain at 30 days postoperatively ( $\text{MD}=0.09$ , 95% CI (-0.29, 0.46), $P=0.65$ ), and ODI at 30 days postoperatively ( $\text{MD}=-0.81$ , 95% CI (-3.03, 1.41), $P=0.47$ ). Conclusions. Current evidence suggests that both UBE and PELD are effective in relieving short-term postoperative pain and promoting functional recovery, and there is no difference in complications between them; UBE requires longer operation time, and PELD may be superior in relieving immediate postoperative pain. This trial is registered with PROSPERO ID: CRD42021287810.