Comparative Analysis of Incidental Dural Tear Rates in Uniportal versus Biportal Endoscopic Lumbar Surgery

Purpose : This systematic review and meta-analysis compares incidental dural tear rates between uniportal and biportal endoscopic lumbar surgeries. Uniportal and biportal techniques represent established minimally invasive approaches, though differential risks for complications such as dural tears warrant thorough investigation. Methods : A comprehensive literature search across Google Scholar, PubMed/MEDLINE, and Cochrane Library identified 67 studies, encompassing 10,491 patients (4,657 biportal, 5,834 uniportal). Results : Initial pooled analysis indicated a higher dural tear incidence in the biportal group (3.16%, 152/4,657) compared to the uniportal group (1.69%, 100/5,834), a statistically significant difference (p < 0.001). However, a more focused meta-analysis of 25 studies revealed no statistically significant difference in pooled dural tear incidences (uniportal: 1.4% [95% CI: 0.3-2.4%] vs. biportal: 1.1% [95% CI: 0.6-1.7%], p = 0.42). Secondary outcomes showed biportal endoscopy associated with slightly shorter operative times, while uniportal surgery correlated with shorter hospital stays. Both approaches yielded comparable functional outcomes. Conclusion : While initial data suggested a difference, the meta-analysis found no significant disparity in dural tear risk. Optimal technique selection, considering patient and surgical factors, remains important for minimizing complications.