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ABSTRACT

Posterior cervical decompression techniques have proven effective in significantly improving cervical radiculopathy. Although the traditional open decompression approach is considered the gold standard, its invasive nature and the challenges associated with postoperative recovery have contributed to its progressive replacement by minimally invasive methods, such as endoscopic tubular techniques and fully endoscopic, uniportal, or biportal approaches. Therefore, this study aims to compare the clinical and surgical out-comes of different posterior techniques in the treatment of cervical radiculopathy through a network meta-analysis. A systematic review with network meta-analysis was conducted using the following keywords: “Cervical radiculopathy,” “Open decompression,” “Tubular decompression,” “Biportal endoscopic decompression,” and “Full-endoscopic decompression”. For comparisons of dichotomous or categorical outcomes, effects were expressed as odds ratios (ORs) using the Mantel-Haenszel method. For continuous variables, effects were presented as mean differences (MDs) using the DerSimonian and Laird method. Pairwise comparisons were used to allow inferences within the framework of network meta-analysis. Finally, ranking analysis was performed using the SUCRA method. Eight articles were included in the analysis, one of which was subdivided into two separate entries, totaling nine entries in the study. Network analysis revealed a significant difference only in length of hospital stay, with all endoscopic techniques demonstrating significant reductions compared to open approaches. In the ranking analysis (SUCRA), the uniportal endoscopic technique was more likely to be the best option in five of the seven outcomes assessed. In turn, the biportal technique proved superior in outcomes related to the cervical disability index (NDI) and surgical time. Endoscopic techniques for the treatment of cervical radiculopathy demonstrate efficacy and safety, with clinical outcomes comparable to those of the open approach. According to the ranking analysis (SUCRA), the uniportal endoscopic technique is more likely to be the best option compared to the biportal, tubular endoscopic, and open microscopy approaches.

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