Systematic review and meta-analysis of delta large-channel endoscopy in spinal decompression

Delta large-channel endoscopy (DCE) is a novel approach to decompressing spinal nerves that expands the working channel of endoscopic approaches. The goal of this systematic review and meta-analysis was to assess the current literature and compare surgical and clinical outcomes between DCE and conventional techniques for decompression laminotomy. This systematic review was conducted following the PRISMA Guidelines to assess articles comparing DCE to existing techniques for decompression laminotomy. PubMed and Embase were queried for studies comparing DCE and any conventional method. Operative time, intraoperative bleeding, hospital stay, incision length, complications, VAS-LBP, VAS-LP, and ODI were recorded. All meta-analyses were conducted using STATA 19.0 (College Station, TX). Our final review included nine studies with 824 patients, 419 of whom were treated with DCE and 405 with other techniques. DCE was associated with significantly shorter hospital stay (MD = −1.37; CI (− 2.54 to −0.20); p = 0.02) and lower intraoperative bleeding volume (MD = −34.47; CI (− 65.81 to −3.13); p = 0.03) compared to comparator techniques, with the bleeding volume advantage driven primarily by comparisons against non-endoscopic techniques (MD = −57.14; CI (− 100.65 to −13.64); p = 0.01) rather than other endoscopic systems ( p = 0.28). No significant differences were observed in operative time ( p = 0.54), complication rates (OR = 0.83; p = 0.56), dural tear rates ( p = 0.92), post-operative VAS back pain (MD = 0.00; p = 0.97), VAS leg pain (MD = −0.05; p = 0.37), or ODI scores (MD = −0.70; p = 0.09). This review found that DCE demonstrates comparable functional outcomes and safety profiles to alternative lumbar decompression techniques, with potential perioperative advantages in hospital stay and intraoperative blood loss, particularly when compared against non-endoscopic techniques. High-quality randomized controlled trials with standardized outcome reporting are needed to confirm these findings and further establish the role of DCE in the surgical management of lumbar degenerative disease.