Minimally invasive endoscopic treatment of cervical radiculopathy: a comparative study of three surgical channel approaches

To compare the clinical efficacy, safety, and surgery-related outcomes of percutaneous endoscopic surgery (PE), unilateral biportal endoscopic surgery (UBE), and large-channel endoscopic surgery (Delta) for the treatment of cervical spondylotic radiculopathy (CSR) using a network meta-analysis.

PubMed, Embase, Web of Science, the Cochrane Library, China National Knowledge Infrastructure (CNKI), Wanfang Data, and the Chinese Biomedical Literature Database (CBM) were systematically searched from database inception to March 15, 2026. Comparative studies involving patients with CSR treated with PE, UBE, and Delta were included. The primary outcomes were operative time, Visual Analog Scale score for neck pain (VAS-neck), Visual Analog Scale score for arm pain (VAS-arm), Neck Disability Index (NDI), and incidence of complications. A random-effects network meta-analysis was performed within a frequentist framework using Stata 16.0 by integrating both direct and indirect evidence. Continuous variables were expressed as mean differences (MDs) with 95% confidence intervals (CIs), and dichotomous variables were expressed as odds ratios (ORs). Consistency was assessed using the node-splitting method, and the relative effects of different surgical techniques were ranked using the surface under the cumulative ranking curve (SUCRA). Risk of bias and certainty of evidence were evaluated using the ROBINS-I tool and the GRADE approach, respectively.

A total of 12 retrospective studies involving 939 patients were included. The network meta-analysis showed that Delta was associated with a shorter operative time than both PE (MD = 26.14 min, 95% CI11.81–40.47) and UBE (MD = 16.09 min, 95% CI1.98–30.21), while PE had a longer operative time than UBE. No statistically significant differences were observed among the three techniques in neck pain (VAS-neck), cervical function (NDI), or incidence of complications. No obvious statistically significant difference was observed between Delta and PE in arm pain (VAS-arm); however, the effect size was small and its clinical significance was limited. The SUCRA rankings indicated that Delta ranked first for operative time, whereas the rankings for all outcomes reflected only relative probabilities.

Based on the currently available retrospective evidence, the three posterior endoscopic techniques, PE, UBE, and Delta, showed generally comparable performance in pain relief, functional improvement, and safety for the treatment of CSR. Delta was associated with a shorter operative time; however, this finding was mainly derived from retrospective studies and remains subject to potential bias and uncertainty. Therefore, current evidence is insufficient to support a definite overall advantage of Delta. High-quality, multicenter, prospective randomized controlled trials are still needed to further verify the relative effects of these different surgical techniques.