Complication Rates in Lumbar Uniportal Endoscopic Spine Surgery (UESS): A Systematic Review and Proportional Meta-Analysis of the Last Decade

Introduction: Uniportal Endoscopic Spine Surgery (UESS) offers reduced tissue damage, faster recovery, and improved outcomes for lumbar spinal pathologies. However, its steep learning curve may impact complication rates, ranging from 0-30%, highlighting the need for a pooled analysis. This systematic review and meta-analysis aim to evaluate the total and specific complication rates associated with lumbar UESS over the last decade.

Methods: We registered on PROSPERO (CRD42024570377) and systematically searched PubMed, Medline, Embase, and Cochrane Library (Jan 2013–Mar 2024) following PRISMA guidelines. Studies with at least 10 adult patients that reported UESS complication rates were included. Exclusions were conference abstracts, reviews, meta-analyses, non-English studies, and those using microendoscopic, lateral, or oblique approaches. 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 RStudio.

Results: Twenty-one studies with 1,258 patients were included. Most studies were high-quality and retrospective, with one randomized controlled trial. The patient 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 (I² = 65.5%), while specific complications had low to moderate heterogeneity.

Conclusion : This proportional meta-analysis shows UESS has a 9.79% overall complication rate, with dural tears and nerve palsy being the most common. Despite UESS being generally safe for lumbar pathologies, variation in complication rates highlights the need for improved patient selection and further research on complication predictors and long-term outcomes compared to traditional methods.