Endoscopic Spinal Surgery (BESS and UESS) Versus Microscopic Surgery in Lumbar Spinal Stenosis: Systematic Review and Meta-Analysis

Study Design: Systematic Review and Meta-Analysis Objectives: Various minimally invasive surgical techniques have been developed as alternatives to conventional surgery. According to recent studies, endoscopic spinal surgery (ESS) (biportal ESS [BESS] or uniportal ESS [UESS]) is more favorable compared with microscopic spinal surgery (MSS). This systematic review and meta-analysis aimed to assess the latest evidence on the use of ESS compared with MSS in lumbar spinal stenosis. Methods: A systematic electronic search using PubMed, Embase, Cochrane Central Database, and Korea Med was performed until December 2019 to identify studies that compared ESS and MSS in patients with lumbar spinal stenosis. Results: Overall, 1167 patients were included from three randomized controlled trials, six retrospective cohorts, and two prospective case-control studies. This review only presented 3 direct comparative studies. The study had inherent limitations specifically in terms of the study design. Meta-analysis of hospital stay (days) showed significant difference between BESS and MSS, UESS and MSS, BESS +UESS, and MSS at the final follow-up (95% confidence interval [CI]: -3.66 to -.77; P = .003; I-2 = 97%, 95% CI: -2.95 to -1.22; P <.00001; I-2 = 90%, and 95% CI: -2.89 to -1.48; P <.00001; I-2 = 96%, respectively). However, metaanalysis showed no significant difference in other results. Conclusions: Although a shorter duration of hospital stay was observed in ESS, there were no significant differences in efficacy and safety between ESS and MSS. Further studies are required to validate these results.