Unilateral biportal endoscopy versus anterior cervical discectomy and fusion for cervical radiculopathy: a meta-analysis

Abstract

The gold standard treatment for cervical radiculopathy is anterior cervical discectomy and fusion (ACDF). Our study compared ACDF with unilateral biportal endoscopy (UBE) to determine whether or not there is an advantage of the minimally invasive technique. PubMed, Embase, and Cochrane databases were searched for studies that compared UBE to ACDF for cervical radiculopathy. Statistical analysis was performed using Review Manager 5.4. Heterogeneity was examined with I² statistics and a random-effects model was used for all outcomes. Three studies comprising 509 patients with cervical radiculopathy were included. Of the participants studied, 255 underwent UBE (50.1%). There were no significant differences observed across the two groups in the change from baseline of NDI scores (MD: -0.17; 95% CI: -2.50 to 2.17), neck pain (SMD: -0.10; 95% CI: -0.53 to 0.33), and upper limb pain (SMD: -0.19; 95% CI: -0.43 to 0.06; p = 0.13). The UBE group showed a significant increase in operating time (MD: 19.78 min; 95% CI: 13.57 to 25.98 min) and a lower incidence of complications (0.051% vs. 0.094%; OR 0.52; 95% CI 0.25-1.08). UBE is an effective and safe alternative to ACDF, with no significant differences between the two approaches in terms of NDI scores or neck and arm pain. While the UBE group had a longer operating time, it exhibited a lower incidence of postoperative complications.