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Background <p>Minimally invasive endoscopic spine surgery, primarily including Single-Port endoscopic surgery and unilateral biportal endoscopy (UBE), has been widely adopted for treating lumbar disc herniation (LDH). While Single-Port techniques utilize a single channel for both visualization and instrumentation, UBE employs two independent portals, offering distinct technical advantages. This systematic review and meta-analysis aimed to compare the perioperative outcomes, efficacy, and safety of these two procedures to provide evidence for individualized minimally invasive surgical selection.</p> Methods <p>Included studies were identified via systematic searches of five electronic databases (PubMed, Web of Science, Embase, Cochrane Library, Scopus) up to March 2026. Two reviewers independently screened studies, extracted data, and assessed quality using the Newcastle–Ottawa Scale. Meta-analysis was performed using RevMan 5.4.</p> Results <p>Twenty four studies (2096 patients: 953 UBE, 1143 Single-Port) were included. The Single-Port group had shorter operation time, less blood loss, earlier ambulation, and shorter hospital stay (all <i>P</i> &lt; 0.0001), while UBE had fewer fluoroscopies (<i>P</i> &lt; 0.0001). Short-term visual analog scale (VAS)/Oswestry Disability Index (ODI) differences were below minimal clinically important difference (MCID) and clinically insignificant; mid-/long-term outcomes were comparable. Complication rates (OR = 1.10, 95% CI [0.77, 1.58], <i>P</i> = 0.59) and Macnab excellent and good rates (OR = 0.95, 95% CI [0.64, 1.41], <i>P</i> = 0.80) were similar.</p> Conclusions <p>Single-Port and UBE have comparable mid-to-long-term efficacy and safety for LDH. Single-Port appears to have advantages in several perioperative outcomes (e.g., operation time and hospital stay), while UBE requires fewer fluoroscopies, though these findings are accompanied by high heterogeneity. Clinical selection should be individualized based on lesion complexity, surgeon experience, and rehabilitation needs.</p> Trial registration <p>PROSPERO, CRD420251253159.</p>

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Comparison of perioperative outcomes, efficacy, and safety between single-port and biportal endoscopic surgery for lumbar disc herniation: a systematic review and meta-analysis

  • 期刊论文

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  • 发表日期：

    2026年7月7日

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  • Quanheng Yu,
  • Ziwei Zhao,
  • Shichang Liu

摘要

Background

Minimally invasive endoscopic spine surgery, primarily including Single-Port endoscopic surgery and unilateral biportal endoscopy (UBE), has been widely adopted for treating lumbar disc herniation (LDH). While Single-Port techniques utilize a single channel for both visualization and instrumentation, UBE employs two independent portals, offering distinct technical advantages. This systematic review and meta-analysis aimed to compare the perioperative outcomes, efficacy, and safety of these two procedures to provide evidence for individualized minimally invasive surgical selection.

Methods

Included studies were identified via systematic searches of five electronic databases (PubMed, Web of Science, Embase, Cochrane Library, Scopus) up to March 2026. Two reviewers independently screened studies, extracted data, and assessed quality using the Newcastle–Ottawa Scale. Meta-analysis was performed using RevMan 5.4.

Results

Twenty four studies (2096 patients: 953 UBE, 1143 Single-Port) were included. The Single-Port group had shorter operation time, less blood loss, earlier ambulation, and shorter hospital stay (all P < 0.0001), while UBE had fewer fluoroscopies (P < 0.0001). Short-term visual analog scale (VAS)/Oswestry Disability Index (ODI) differences were below minimal clinically important difference (MCID) and clinically insignificant; mid-/long-term outcomes were comparable. Complication rates (OR = 1.10, 95% CI [0.77, 1.58], P = 0.59) and Macnab excellent and good rates (OR = 0.95, 95% CI [0.64, 1.41], P = 0.80) were similar.

Conclusions

Single-Port and UBE have comparable mid-to-long-term efficacy and safety for LDH. Single-Port appears to have advantages in several perioperative outcomes (e.g., operation time and hospital stay), while UBE requires fewer fluoroscopies, though these findings are accompanied by high heterogeneity. Clinical selection should be individualized based on lesion complexity, surgeon experience, and rehabilitation needs.

Trial registration

PROSPERO, CRD420251253159.