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Full-endoscopic (bi-portal or uni-portal) versus microscopic lumbar decompression laminectomy in patients with spinal stenosis: systematic review and meta-analysis

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Abstract

Background

Lumbar stenosis causes pain in the lower lumbar spine and lower extremities and reduces the patient’s quality of life and walking ability. Thus, these conditions are common surgical indications for spinal stenosis. Previous reports have shown satisfactory clinical outcomes of the full-endoscopic (FE) and MI technique decompressive laminectomy for lumbar stenosis. However, they still remain controversial.

Objective

We conducted a systematic review and meta-analysis to compare the postoperative outcomes between FE (bi-portal or uni-portal) and MI technique decompressive laminectomy for lumbar stenosis.

Method

We searched all comparative studies that compared postoperative outcomes (operative time, VAS for back and leg pain, ODI in 3 months and last follow-up) of full-endoscopic (bi-portal or uni-portal) and microscopic technique decompressive laminectomy for lumbar stenosis from the PubMed and Scopus databases up to October 16, 2019.

Results

Nine of 1107 studies (five comparative studies and four RCT) (N = 994 patients) were eligible; all studies were included in pooling of FE and MI decompression. Five and three studies were included in pooling of bi-portal endoscopic, uni-portal endoscopic and MI decompression. All three techniques were compared in one study. Eight, nine, seven, eight, five, seven, eight and nine studies were included in pooling of VAS for back, leg, ODI in 3 months and last follow-up and operative time, respectively. The UMD of VAS for back, leg, ODI in 3 months and last follow-up of FE group was − 0.63 (95% CI − 1.15, − 0.12), − 0.15 (− 0.42, 0.11), − 2.06 (− 3.76, − 0.39), − 0.07 (− 0.22, 0.08), − 0.16 (− 0.29, − 0.03), − 0.20 (− 1.20, 0.81) scores and − 3.00 (− 12.25, 6.25) minutes when compared to MI in lumbar stenosis. In terms of complication, FE was lower risk of 0.62 (0.40, 0.96) times when compared to MI. After subgroup analysis, BESS had significant lower back and leg pain within 3 months when compared to MI group, while uni-portal FE had significant lower leg pain in the last follow-up and complication when compared to MI group. There had no difference in ODI and operative time between two groups.

Conclusion

FE had statistically significant lower back pain, lower leg pain and lower risk of having complications when compared to MI decompression in lumbar stenosis, while there is no difference in ODI and operative time between both groups. Comparing to MI, BESS had better early postoperative back pain while uni-portal FE had better leg pain and risk of having complications. Larger, prospective randomized controlled studies are needed to confirm these findings as the current literature is still insufficient.

Level of evidence

III.

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Abbreviations

FE:

Full-endoscopic

UPFE:

Percutaneous uni-portal full-endoscopic

BESS:

Bi-portal endoscopic spinal surgery

MI:

Microscopic

VAS:

Visual analogue score

RCT:

Randomized controlled trial

ODI:

Oswestry disability index

SD:

Standard deviation

PRISMA:

Preferred reporting items for systematic reviews and meta-analyses

UMD:

Unstandardized mean difference

OR:

Odds ratio

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Acknowledgements

All authors declare no funding source or sponsor involvement in the study design, collection, analysis and interpretation of the data, in writing the manuscript and in submission of the manuscript for publication.

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Contributions

SP was responsible for the conception and design, collection and assembly of data, analysis and interpretation of the data, drafting of the manuscript and final approval of the article. JAM was responsible for the conception and design, collection and assembly of data, critical revision of the manuscript for important intellectual content and final approval of the article. JH was responsible for manuscript writing. AA was responsible for manuscript writing, critical revision of the manuscript for important intellectual contents and final approval of the article. JK was responsible for the conception and design, collection and assembly of data, supervision of analysis and interpretation of the data, writing the manuscript, critical revision of the manuscript for important intellectual contents, final approval of the article and statistical expertise.

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Correspondence to Jatupon Kongtharvonskul.

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Appendices

Appendix 1

Search term and search strategy

#1 lumbar stenosis.

#2 micro.

#3 endoscopic.

#4 minimally invasive.

#5 lumbar decompression.

#6 lumbar laminectomy.

#7 lumbar spine surgery.

#8 #2 or #3 or #4.

#9 #5 or #6 or #7.

#10 #1 and #8 and #9.

Appendix 2

See Table 6.

Table 6 Criteria for risk of bias assessment

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Pairuchvej, S., Muljadi, J.A., Ho, Jc. et al. Full-endoscopic (bi-portal or uni-portal) versus microscopic lumbar decompression laminectomy in patients with spinal stenosis: systematic review and meta-analysis. Eur J Orthop Surg Traumatol 30, 595–611 (2020). https://doi.org/10.1007/s00590-019-02604-2

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