Study Design: Systematic review and meta-analysis. Objective: Although uniportal and biportal endoscopic decompression have emerged as promising minimally invasive options for the management of lumbar spinal stenosis (LSS), their relative advantages remain debated. This systematic review and meta-analysis aims to evaluate the efficacy and safety of both approaches in LSS treatment. Methods: In adherence to the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) guidelines, we systematically searched PubMed, Embase, Cochrane Library, and Web of science for randomized controlled trials and observational studies comparing the outcomes of uniportal and biportal endoscopic techniques for LSS treatment. Meta-analysis was performed using a random-effects model. Results: A total of 11 studies were included, comprising 1199 patients. Biportal endoscopy was associated with a significantly lower operation time ( P < .01), Oswestry Disability Index (ODI) at 12 months ( P < .01), and higher postoperative dural sac area ( P < .01) and dural sac area expansion ( P = .02). There were no significant differences between groups in intraoperative blood loss, hospitalization time, back pain, leg pain, or ODI at other timepoints, ipsilateral facetectomy angle, and overall complications, including dural tear, infection, postoperative hematoma, lower limb numbness, and nerve root injury. Conclusion: In this meta-analysis, biportal endoscopic decompression demonstrated significantly lower operation time, ODI at 12 months, and higher postoperative dural sac area and dural sac area expansion, although both techniques showed similar safety profiles and complication rates. Further high-quality studies are needed to better assess the advantages of both techniques for LSS treatment.

This meta-analysis compares clinical outcomes of minimally invasive decompression (MID) versus open laminectomy surgery (OLS) for multilevel lumbar spinal stenosis. A systematic search was conducted in PubMed, Embase, and the Cochrane Central databases to identify studies comparing MID to OLS in patients with multilevel lumbar spinal stenosis. Primary outcomes were length of hospital stay (LHS), operative time (OT), complication rate (CR), intraoperative blood loss (IBL), reoperation due to recurrence (RDR), and low back pain 1 year after surgery (LBP). Of 3695 articles screened, 4 studies and 618 patients were included, of whom 291 (47%) were treated with MID and 327 (53%) were treated with OLS. There were no significant differences between the groups in OT (Mean Difference (MD)) = 7.68; 95% CI [-20.53, 35.88]; p = 0.59, I² = 96%), CR (Odds Ratio (OR)) = 0.72; 95% CI [0.04, 14.73]; p = 0.83; I² = 80%), RDR, LBP and LHS. However, IBL was reduced in MID compared to OLS (MD = -55.20; 95% CI [-105.73, -4.67]; p = 0.03; I² = 95%), decreasing the need for transfusions and complications. Only the RDR presented a low heterogeneity, while the rest of the outcomes conferred a high heterogeneity. Our study showed important statistical differences between the groups analyzed, likely attributable to inconsistencies in standardized approaches and decompression techniques across studies. Notably, MID demonstrated an advantage over OLS regarding intraoperative blood management.

Robotic-assisted minimally invasive surgery (RA-MIS) is becoming increasingly applied to spinal surgery, offering an alternative to conventional minimally invasive spinal surgery (C-MIS). Recently, RA-MIS has been proposed for pedicle screw instrumentation in thoracolumbar fractures. This review aims to evaluate screw accuracy, RA-MIS and C-MIS among the thoracolumbar fracture population. This study followed PRISMA and Cochrane guidelines. Five medical databases were searched. Finally, 10 studies were included in the meta-analysis, with a total of 562 patients. Outcomes on operation time, blood loss, pedicle screw accuracy, complications, and cost-effectiveness were evaluated. RA-MIS showed superiority in terms of accurate (GR A) screw placement (OR: 3.58, 95% CI: 2.30-5.58, p<.001) and satisfactory (GR A+B) screw placement (OR: 3.86, 95% CI: 2.14-6.96, p<.001) compared to C-MIS. RA-MIS led to a significantly lower incidence of severely misplaced (GR D+E) screws (OR: 0.26, 95% CI: 0.13-0.51, p<.001) and lower blood loss (MD: -12.03, 95% CI: -20.85 to -3.21, p<.01). However, we found no statistically significant differences in operation time (MD: -4.92, 95% CI: -12.06 to 2.22, p=.18) or complications (screw loosening, nerve injury, or infection). Costs of RA-MIS were significantly higher (MD: ¥8657.61, 95% CI: 6651.39 to 10663.83, p<.01). Robotic-assisted minimally invasive spinal surgery is superior in terms of higher pedicle screw accuracy and reduced perioperative blood loss, at the cost of significantly higher costs of surgery. Furthermore, we observed no clear advantages regarding complication rate and total operation time. Future trials should provide a less biased methodology to confirm the findings.

Ventriculoperitoneal shunt (VPS) is the standard treatment for hydrocephalus in neonates and infants, but is commonly complicated by shunt infections. Antibiotic-impregnated catheters (AICs) have been introduced to mitigate infection risk; however, their effectiveness remains uncertain. We conducted a systematic review and meta-analysis comparing outcomes in neonates and infants who underwent VPS with and without AICs. Primary outcomes included shunt infection risk, time to first infection, and infections caused by gram-positive cocci and gram-negative rods. Pooled odds ratios (ORs), mean differences, and 95% confidence intervals (CIs) were calculated using random-effects models. Seven studies encompassing 1,009 patients were included. The use of AICs was associated with a significant three-fold reduction in overall shunt infection risk compared to standard catheters (OR 0.27; 95% CI 0.15-1.03; P < 0.01; I² = 0%). Subgroup analysis showed significant infection risk reduction in infants (OR 0.29; 95% CI 0.12-0.67; P = 0.004) and neonates (OR 0.26; 95% CI 0.11-0.62; P < 0.01). AICs led to a significant decrease in gram-positive cocci infections (OR 0.20; 95% CI 0.06-0.69; P = 0.01) but not gram-negative rod infections. The time to first infection was significantly prolonged in the AIC group (mean difference 4.6 months; 95% CI 2.2-6.9; P < 0.01). Lower infection risk persisted at 6 months and beyond. AICs substantially reduce infection risk and delay infection onset in neonates and infants undergoing VPS, particularly for gram-positive bacteria. Routine use is recommended.