Meta-Analysis of Complications in Minimally Invasive Spine Surgery (2013–2024)
Bibliographic record
Abstract
STUDY DESIGN: Systematic review and proportional meta-analysis. OBJECTIVE: To assess total and specific complication rates associated with lumbar biportal endoscopic spine surgery (BESS). SUMMARY OF BACKGROUND DATA: In recent years, BESS has emerged as an effective minimally invasive technique for treating lumbar spine conditions, offering benefits such as reduced tissue damage and improved outcomes. However, the safety of BESS across lumbar pathologies is underexplored, with complication rates reported up to 50%. METHODS: We registered on PROSPERO (CRD42024570377) and systematically searched PubMed, Medline, Embase, and Cochrane Library (Jan 2013-Mar 2024) per PRISMA guidelines. Studies were included if they focused on lumbar BESS in cohorts of at least 10 adult patients and provided extractable complication data. We excluded conference abstracts, reviews, meta-analyses, non-English studies, and those using microendoscopic, lateral, or oblique approaches. A random-effects model was used to pool complication rates, and study quality was assessed using the Cochrane Risk of Bias Tool and Newcastle-Ottawa Scale. Analyses were performed in R Studio. RESULTS: Seventy-five studies with 4404 patients (sample sizes 10-797) were included. Most studies were retrospective and geographically concentrated in China and Korea. Patients ranged from 27.6 to 80 years old, with 51.8% being male, and follow-up durations spanned from 3 to 27.5 months. The overall pooled complication rate for lumbar BESS was 7.75% (95% CI: 5.97%, 10.01%). Specific complication rates included dural tears (2.64%), nerve palsies (1.33%), postoperative hematomas (1.80%), surgical site infections (0.20%), and surgical revisions (1.68%). Total complication rates showed significant heterogeneity (I²=82.0%, P <0.01), while specific complications exhibited low to moderate heterogeneity. CONCLUSIONS: Lumbar BESS has a low overall complication rate of 7.75%, with dural tears and nerve palsies being the most common. Results should be interpreted with caution due to significant heterogeneity. Future research should explore risk factors of specific complication types and compare long-term outcomes with traditional methods.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.020 | 0.039 |
| Meta-epidemiology (narrow) | 0.004 | 0.002 |
| Meta-epidemiology (broad) | 0.023 | 0.074 |
| Bibliometrics | 0.009 | 0.009 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.004 | 0.002 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.003 | 0.003 |
| Insufficient payload (model declined to judge) | 0.005 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".