Comparison of unilateral biportal endoscopy (UBE) and percutaneous endoscopic lumbar discectomy (PELD) for the treatment of single-level lumbar disc herniation

Background : This study aimed to compare the clinical efficacy of unilateral biportal endoscopy (UBE) and percutaneous endoscopic lumbar discectomy (PELD) for treating single-level disc herniation. Patients and Methods: A retrospective analysis was conducted on patients with lumbar disc herniation treated in the Spinal Surgery Department of Zhaoqing First People's Hospital between January 2021 and December 2023. A total of 51 patients underwent minimally invasive spinal endoscopy, with 23 patients in the UBE group and 28 in the PELD group. All patients were followed up for a minimum of one year. The demographic characteristics, Pfirrmann grades, intraoperative and postoperative data, complications, and prognostic indicators of intervertebral disc degeneration were reviewed and analyzed for both groups. Clinical outcomes were evaluated using the Japanese Orthopaedic Association (JOA) scores, Oswestry disability index (ODI), visual analog scale (VAS) score, and modified Macnab criteria. All procedures were performed by experienced surgeons, and postoperative evaluation included MRI. Results: No significant differences were observed in the demographic characteristics between the two groups, including gender, age, American Society of Anesthesiologists (ASA) score, responsible segment composition, follow-up duration, and Pfirrmann grade of disc degeneration. UBE demonstrated significant advantages over PELD in terms of anesthesia duration, surgery duration, blood loss, and incision length (p < 0.05). Additionally, the intraoperative fluoroscopy time was shorter for UBE than for PELD (p < 0.05), resulting in reduced radiation exposure to surgeons. Postoperative JOA, VAS, ODI, and modified Macnab scores improved significantly in both groups compared to preoperative values (p < 0.05), with no significant differences between the groups (p > 0.05). Complications included two cases of dural sac injury in the UBE group and one case of nerve root traction injury in the PELD group. Conclusion: Both UBE and PELD are safe and effective for treating single-segment lumbar disc herniation. UBE offers a wider intraoperative field of view and greater flexibility during surgery. PELD is less invasive and allows faster perioperative recovery; however,PELD requires steeper learning curve due to narrower working channel.