Complications in Minimally Invasive Spine Surgery (2013-2024): A Proportional Meta-Analysis -Uniportal Endoscopic Spine Surgery (UESS).

STUDY

DESIGN

Systematic review and proportional meta-analysis.

OBJECTIVE

To evaluate overall and specific complication rates associated with lumbar uniportal endoscopic spine surgery (UESS) over the past decade.

SUMMARY OF BACKGROUND DATA: UESS offers reduced tissue damage, faster recovery, and improved outcomes for lumbar spinal pathologies. However, its steep learning curve may contribute to variable complication rates, reported between 0% and 30%, highlighting the need for a pooled analysis.

METHODS

We registered this review in the International Prospective Register of Systematic Reviews (CRD42024570377). We systematically searched PubMed, Medline, Embase, and Cochrane Library (January 2013-March 2024) following PRISMA guidelines. Studies with at least 10 adult patients that reported UESS complication rates were included. Conference abstracts, reviews, meta-analyses, non-English studies, and studies using micro-endoscopic, lateral, or oblique approaches were excluded. 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 R Studio.

RESULTS

Twenty-one studies with 1258 patients were included. Most studies were high quality and retrospective, with one randomized controlled trial. The patient's 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%), whereas specific complications had low to moderate heterogeneity.

CONCLUSIONS

Lumbar UESS demonstrated a 9.79% overall complication rate, with dural tears and nerve palsy being the most common. Despite UESS being generally safe, complication variability highlights the need for better patient selection and long-term outcome research.