Unilateral biportal endoscopic transforaminal lumbar interbody fusion versus minimally invasive transforaminal lumbar interbody fusion for single-level lumbar spondylolisthesis: a systematic review and meta-analysis

Objective As an emerging surgical technique, the potential advantages of unilateral biportal endoscopic transforaminal lumbar interbody fusion (ULIF) for lumbar spondylolisthesis have yet to be substantiated by robust evidence. This study aims to investigate effectiveness and security of ULIF compared to minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) in managing single-level lumbar spondylolisthesis. Methods We conducted a comprehensive search in six databases for publications comparing ULIF with MIS-TLIF for lumbar spondylolisthesis, systematically reviewing literature up until July 19, 2025. Meta-analyses were carried out via Stata 17.0 software. Results Twelve studies met our inclusion criteria. Compared with MIS-TLIF, ULIF demonstrated significantly reduced intraoperative blood loss WMD = −35.71, 95% CI (−51.80, −19.63), p 0.01, fewer intraoperative fluoroscopy times WMD = −1.29, 95% CI (−2.56, −0.02), p 0.05, lower postoperative drainage volume WMD = −20.64, 95% CI (−37.13, −4.15), p = 0.01, shorter postoperative ambulation time WMD = −0.30, 95% CI (−0.42, −0.17), p 0.01, and decreased hospital stay duration WMD = −1.50, 95% CI (−2.09, −0.90), p 0.01. Additionally, patients undergoing ULIF exhibited improved visual analog scale scores for back pain WMD = −0.09, 95% CI (−0.16, −0.02), p = 0.01 and leg pain WMD = −0.09, 95% CI (−0.16, −0.03), p = 0.01 and Oswestry disability index WMD = −0.77, 95% CI (−1.21, −0.32), p 0.01 at final follow-up. Conversely, surgical duration for MIS-TLIF was significantly shorter than that for ULIF WMD = 18.63, 95% CI (9.39, 27.87), p 0.01. No significant differences were observed between both groups regarding disc height, lumbar lordosis, fusion rates, or complication rates ( p 0.05). Conclusion In comparison to MIS-TLIF, ULIF presents several advantages including less intraoperative blood loss, reduced reliance on fluoroscopy, diminished postoperative drainage, earlier ambulation capabilities after surgery, shorter hospital stay as well as enhanced recovery from back and leg pain along with improved lumbar function in patients affected by lumbar spondylolisthesis. However, ULIF requires more operative time than MIS-TLIF. Systematic review registration https://www.crd.york.ac.uk/PROSPERO/view/CRD42025111069 , CRD420251110694.