Biportal endoscopic versus conventional open spine surgery for lumbar degenerative disease: a systematic review and meta‑analysis

This study was the first comprehensive systematic review and meta-analysis to compare clinical outcomes between conventional open surgery and biportal endoscopy for decompression and fusion of lumbar degenerative disease. Although conventional open spine surgery has been the standard approach for decades, biportal endoscopy has gained attention as a minimally invasive alternative with potential surgical outcome benefits. Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, we performed a systematic review and meta-analysis including eight comparative studies on open and biportal endoscopic spine surgery. A comprehensive search of PubMed, Embase, and Scopus identified studies that reported outcomes, such as the Oswestry Disability Index (ODI), Visual Analog Scale (VAS) scores for back and leg pain, complication rates, operative time, and hospital stay. Data were analyzed using a random effects model to evaluate the effect size between the two approaches. We analyzed 414 open and 383 biportal endoscopic lumbar surgical procedures. The open group had a mean age of 61.0 years and comprised 42.0% men, whereas the biportal group had a mean age of 59.8 years and comprised 46.7% men. Compared with open spine surgery, biportal surgery was associated with a significantly longer operative time but shorter length of hospital stay and similar preoperative VAS scores, ODI score, and postoperative outcomes at 1 year. Fusion subgroup analysis showed significantly lower VAS score for back pain with biportal surgery than with open surgery, but the other measures were comparable. Despite its longer operative time, biportal endoscopy led to shorter hospital stay and similar long-term pain and disability outcomes, compared with open spine surgery. Given the significant improvement in short-term leg pain relief after fusion procedures, biportal endoscopic spine surgery is a potential minimally invasive alternative to open surgery that warrants further study.