Unilateral biportal endoscopic transforaminal lumbar interbody fusion versus minimally invasive transforaminal lumbar interbody fusion for single-level lumbar spondylolisthesis: a systematic review and meta-analysis.

OBJECTIVE

As an emerging surgical technique, the potential advantages of unilateral biportal endoscopic transforaminal lumbar interbody fusion (ULIF) for lumbar spondylolisthesis have yet to be substantiated by robust evidence. This study aims to investigate effectiveness and security of ULIF compared to minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) in managing single-level lumbar spondylolisthesis.

METHODS

We conducted a comprehensive search in six databases for publications comparing ULIF with MIS-TLIF for lumbar spondylolisthesis, systematically reviewing literature up until July 19, 2025. Meta-analyses were carried out via Stata 17.0 software.

RESULTS

Twelve studies met our inclusion criteria. Compared with MIS-TLIF, ULIF demonstrated significantly reduced intraoperative blood loss [WMD = -35.71, 95% CI (-51.80, -19.63), p < 0.01], fewer intraoperative fluoroscopy times [WMD = -1.29, 95% CI (-2.56, -0.02), p < 0.05], lower postoperative drainage volume [WMD = -20.64, 95% CI (-37.13, -4.15), p = 0.01], shorter postoperative ambulation time [WMD = -0.30, 95% CI (-0.42, -0.17), p < 0.01], and decreased hospital stay duration [WMD = -1.50, 95% CI (-2.09, -0.90), p < 0.01]. Additionally, patients undergoing ULIF exhibited improved visual analog scale scores for back pain [WMD = -0.09, 95% CI (-0.16, -0.02), p = 0.01] and leg pain [WMD = -0.09, 95% CI (-0.16, -0.03), p = 0.01] and Oswestry disability index [WMD = -0.77, 95% CI (-1.21, -0.32), p < 0.01] at final follow-up. Conversely, surgical duration for MIS-TLIF was significantly shorter than that for ULIF [WMD = 18.63, 95% CI (9.39, 27.87), p < 0.01]. No significant differences were observed between both groups regarding disc height, lumbar lordosis, fusion rates, or complication rates (p > 0.05).

CONCLUSION

In comparison to MIS-TLIF, ULIF presents several advantages including less intraoperative blood loss, reduced reliance on fluoroscopy, diminished postoperative drainage, earlier ambulation capabilities after surgery, shorter hospital stay as well as enhanced recovery from back and leg pain along with improved lumbar function in patients affected by lumbar spondylolisthesis. However, ULIF requires more operative time than MIS-TLIF.

SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/PROSPERO/view/CRD42025111069, CRD420251110694.