Comparative Effectiveness and Safety of Unilateral Hemilaminectomy, Unilateral Biportal Endoscopic Decompression, and Percutaneous Transforaminal Endoscopic Surgery for Lumbar Degenerative Disease: A Systematic Review and Meta-Analysis With Pathology-Stra

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22 studies, including 8 randomized controlled trials (RCTs) and 14 prospective cohort studies involving 3362 patients with lumbar disc herniation (LDH) or lumbar spinal stenosis (LSS), were included in this systematic review and meta-analysis comparing unilateral hemilaminectomy (UH), unilateral biportal endoscopic decompression (UBE), and percutaneous transforaminal endoscopic surgery (PTES). Pooled outcomes included the Oswestry Disability Index (ODI), Visual Analog Scale (VAS) pain scores, operative time, blood loss, surgical complications, dural tears, and reoperation rates. Both endoscopic techniques significantly improved disability scores compared with UH at 12 months, although these improvements remained below the minimum clinically important difference (MCID). Additionally, endoscopic approaches were associated with fewer complications and reoperations, while PTES reduced operative time, blood loss, and dural tears. These findings suggested that endoscopic decompression may offer perioperative and safety advantages, although functional improvements were insufficient to establish superiority based on clinical importance.