Complications in Minimally Invasive Spine Surgery (2013–2024)

Study Design. Systematic review and proportional meta-analysis. Objective. To evaluate overall and specific complication rates associated with lumbar uniportal endoscopic spine surgery (UESS) over the past decade. Summary of Background Data. UESS offers reduced tissue damage, faster recovery, and improved outcomes for lumbar spinal pathologies. However, its steep learning curve may contribute to variable complication rates, reported between 0% and 30%, highlighting the need for a pooled analysis. Methods. We registered this review in the International Prospective Register of Systematic Reviews (CRD42024570377). We systematically searched PubMed, Medline, Embase, and Cochrane Library (January 2013–March 2024) following PRISMA guidelines. Studies with at least 10 adult patients that reported UESS complication rates were included. Conference abstracts, reviews, meta-analyses, non-English studies, and studies using micro-endoscopic, lateral, or oblique approaches were excluded. A random-effects model was used to pool complication rates. Study quality was assessed using the Cochrane Risk of Bias Tool and Newcastle-Ottawa Scale. Analyses were conducted with R Studio. Results. Twenty-one studies with 1258 patients were included. Most studies were high quality and retrospective, with one randomized controlled trial. The patient’s age ranged from 41.6 to 73.5 years, with 38.7% male, and follow-up periods between 6 and 26.5 months. The studies mainly focused on lumbar spinal stenosis treatment and were primarily conducted in China and Korea. The total pooled complication rate was 9.79% 95% CI (7.00%, 13.53%). Specific complication rates included dural tears (3.75%), nerve palsies (2.69%), postoperative hematomas (0.24%), surgical site infections (0.01%), and surgical revisions (2.39%). Total complication rates showed significant heterogeneity ( I ²=65.5%), whereas specific complications had low to moderate heterogeneity. Conclusions. Lumbar UESS demonstrated a 9.79% overall complication rate, with dural tears and nerve palsy being the most common. Despite UESS being generally safe, complication variability highlights the need for better patient selection and long-term outcome research.