Pain relief and functional outcomes after minimally invasive endoscopic decompression for cervical radiculopathy

To systematically compare the clinical efficacy, safety, and surgical efficiency of 3 posterior endoscopic techniques - percutaneous endoscopic surgery (PE), unilateral biportal endoscopic surgery (UBE), and large-channel endoscopic surgery (Delta) - for cervical radiculopathy using a network meta-analysis, providing evidence-based guidance for surgical approach selection.

The Cochrane Library, China National Knowledge Infrastructure, PubMed, Embase, Web of Science, Wanfang Data, and the Chinese Biomedical Literature Database were searched from inception to November 15, 2025. Randomized controlled trials and observational studies comparing PE, UBE, and Delta for cervical radiculopathy were included. Two reviewers independently conducted study selection, data extraction, and quality assessment. A random-effects network meta-analysis was performed using Stata 16.0 (StataCorp). Outcomes included operative time, visual analogue scale for neck pain, visual analogue scale for arm pain, neck disability index, and complications. Treatment rankings were estimated using surface under the cumulative ranking curve (SUCRA). Consistency, publication bias, and small-study effects were assessed. The study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Network Meta-Analyses statement but was not prospectively registered and had no publicly available protocol.

Eleven retrospective studies were included. Operative time was significantly shorter with Delta than with PE or UBE, and shorter with UBE than with PE. Delta ranked highest for surgical efficiency, with a SUCRA value of 99.1%. No significant differences were found among the 3 techniques in visual analogue scale for neck pain or neck disability index improvement. For visual analogue scale for arm pain, Delta showed a potential advantage over PE and had the highest SUCRA probability of 97.3%. Complication rates did not differ significantly among groups. No significant network inconsistency was detected, and comparison-adjusted funnel plots showed no obvious publication bias or small-study effects. However, because the number of studies was limited and all were retrospective, the findings should be interpreted cautiously.

PE, UBE, and Delta posterior endoscopic techniques showed generally comparable clinical efficacy and safety for cervical radiculopathy. Delta demonstrated superior surgical efficiency and may offer potential advantages in arm pain relief. Given the retrospective nature of the evidence and heterogeneity in some outcomes, further high-quality prospective studies are needed.