Arthroscopic-assisted uni-portal spinal surgery versus unilateral biportal endoscopy for lumbar degenerative diseases: a systematic review and meta-analysis of clinical outcomes and complications

Abstract

Abstract Background The optimal endoscopic surgical approach for lumbar degenerative diseases remains debated. This meta-analysis compared the clinical performance and safety of arthroscopic-assisted uni-portal spinal surgery (AUSS) versus unilateral biportal endoscopy (UBE/BESS). To provide guidance on the choice of surgical approaches of the lumbar degenerative diseases. Methods A systematic literature search was performed across PubMed, Embase, Web of Science, Cochrane Database, China National Knowledge Network, Wanfang Database, and China Biomedical Literature Database up to March 28, 2026. Studies comparing AUSS and UBE/BESS for lumbar degenerative conditions were included. We analyzed the extracted data with Review Manager 5.4. Results Three studies encompassing 810 patients (419 AUSS, 391 UBE/BESS) were analyzed. The AUSS group demonstrated significantly reduced operative time (MD = -14.72, 95% CI: −22.32 to − 7.12, P = 0.0001), lower intraoperative blood loss (MD =−10.59, 95% CI: −16.92 to − 4.26, P = 0.001), shorter incision length (MD = − 1.43, 95% CI: −1.64 to − 1.22, P < 0.00001), lower Visual Analog Scale (VAS) scores for back pain 3 months post-surgery (MD = -0.14, 95%CI: -0.24 to -0.03, P = 0.01), The excellent and good outcome rate was also higher in the AUSS group (OR = 1.52, 95%CI: 1.01 to 2.28, P = 0.04); No significant between-group differences emerged for hospital stay, Oswestry Disability Index (ODI) at any postoperative timepoint, or complication rates. Conclusions Both techniques are safe and effective for lumbar degenerative diseases, with comparable functional recovery and safety profiles. AUSS appears to be associated with improved surgical efficiency, but these findings are exploratory and require confirmation by high-quality RCTs.