Related Experiment Video
Updated: Aug 8, 2026
The Third Channel-Assisted Unilateral Biportal Endoscopic Technique for Lumbar Spinal Stenosis Combined with Contralateral Disc Herniation
Published on: November 17, 2023
Biportal endoscopic revision discectomy versus open microdiscectomy for recurrent lumbar disc herniation without
Muhammad Ramadhan Ghifari1, Akmal Abdurrahim Tan1
1Department of Neurology, Faculty of Medicine, Universitas Muhammadiyah Purwokerto, Purwokerto, Indonesia.
Background:
Revision surgery for recurrent lumbar disc herniation (RLDH) without instability is technically demanding because epidural scarring alters tissue planes. Biportal endoscopic revision discectomy may reduce access-related morbidity, but comparative evidence remains limited.
Objective:
To compare biportal endoscopic revision discectomy with open microdiscectomy for RLDH without instability.
Methods:
PubMed, Scopus, and ScienceDirect were searched from inception to 21 June 2026. Comparative adult studies were eligible. Random-effects meta-analyses calculated mean differences (MDs) and risk ratios (RRs) with 95% confidence intervals (CIs). Risk of bias was assessed using the seven-domain ROBINS-I tool. Exploratory trial sequential analysis (TSA) was performed for conventionally significant outcomes. The protocol was registered in PROSPERO (CRD420261429196).
Results:
Three retrospective studies including 208 patients were analyzed: 91 underwent biportal surgery and 117 underwent open microdiscectomy. Biportal surgery was associated with shorter hospital stay (MD, -1.54 days; 95% CI, -2.73 to -0.36; I2 = 83%) and slightly lower long-term back-pain scores (MD, -0.37 points; 95% CI, -0.66 to -0.07; I2 = 0%). TSA did not confirm firm evidence for hospital stay (DARIS = 503; final Z = 2.56; boundary not crossed), whereas the long-term back-pain Z-curve crossed the monitoring boundary (DARIS = 28; final Z = 2.46). No significant differences were found in operative time, long-term leg pain, MacNab outcome, recurrence, durotomy, or overall complications. All studies had serious overall risk of bias.
Conclusions:
Biportal endoscopic revision discectomy may offer recovery-related advantages, but current evidence remains preliminary and does not establish superiority, equivalence, or noninferiority.
