Uniportal endoscopic lumbar interbody fusion versus minimally invasive transforaminal lumbar interbody fusion for the treatment of lumbar degenerative diseases: a systematic review and meta-analysis.

objectiveThis study aimed to compare the efficacy and complication of uniportal endoscopic lumbar interbody fusion (UELIF) with minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) regarding the management of lumbar degenerative diseases.

methodsThis study was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and registered with PROSPERO (CRD420251141853). A systematic search was conducted in six databases from their inception to August 5, 2025. Twenty studies, involving 1720 patients, were included in the meta-analysis. Meta-analyses were performed using Stata 17.0. Study quality was assessed using the Newcastle-Ottawa Scale. Egger test, Begg test, and trim‑and‑fill analysis were used to assess the presence of publication bias.

resultsUELIF required significantly longer operative time [WMD = 18.67, 95% CI (0.86, 36.48), p = 0.04] and fluoroscopy duration [WMD = 12.63, 95% CI (9.16, 16.11), p < 0.01] compared to MIS-TLIF. Nevertheless, UELIF demonstrated significant advantages in reducing intraoperative bleeding [WMD = - 66.57, 95% CI (- 90.20, - 42.95), p < 0.01], postoperative creatine kinase [WMD = - 95.76, 95% CI (- 113.52, - 78.00), p < 0.01] and C-reactive protein (CRP) [WMD = - 28.07, 95% CI (- 36.22, - 19.93), p < 0.01], postoperative drainage [WMD = - 39.00, 95% CI (- 55.67, - 22.34), p < 0.01], ambulation time [WMD = - 0.87, 95% CI (- 1.65, - 0.10), p = 0.03], and length of hospital stay [WMD = - 2.00, 95% CI (- 2.91, - 1.09), p < 0.01]. Visual Analog Scale (VAS) scores for back pain were significantly lower in the UELIF group than in the MIS-TLIF group within 7 days postoperatively, at 3 months postoperatively, and at the final follow-up (p < 0.05). VAS scores for leg pain were significantly lower in the UELIF group at 6 months postoperatively (p < 0.05). Oswestry Disability Index (ODI) scores were significantly lower in the UELIF group at 3 months postoperatively (p < 0.05). Japanese Orthopaedic Association (JOA) scores were significantly higher in the UELIF group within 7 days and at 6 months postoperatively, respectively (p < 0.05). No significant differences were observed between the two groups in terms of disc height, lumbar lordosis, fusion rate, or complication rates at the final follow-up (p > 0.05).

conclusionUELIF and MIS-TLIF showed comparable outcomes regarding disc height, lumbar lordosis, fusion rates, and complication rates. Although MIS-TLIF exhibited shorter operation time and reduced intraoperative fluoroscopy duration, UELIF provided significant advantages by minimizing blood loss, postoperative drainage, creatine kinase, CRP, ambulation time, and hospital stays. Furthermore, UELIF showed superior efficacy in alleviating early postoperative low back pain and leg pain and promoting early postoperative lumbar function recovery. Given study limitations, such as the majority of retrospective studies and significant heterogeneity, high-quality multicenter randomized controlled trials are recommended in the future to confirm these findings and guide clinical practice.