Preliminary Outcomes of Patients with Lumbar Disc Herniation Undergoing Unilateral Biportal Endoscopic Spine Surgery: A Single-Center Retrospective Study in Vietnam

Abstract

Objective: Unilateral biportal endoscopic (UBE) treatment for lumbar disc herniation (LDH) is an advanced surgical procedure that has recently gained popularity. Numerous reports from developed countries have demonstrated the effectiveness of this minimally invasive technique. We evaluated the initial outcomes of UBE at a healthcare facility with limited resources. Methods: Clinical and radiographic data of 82 patients with LDH treated between July 2022 and June 2023 using UBE discectomy techniques, including the ipsilateral interlaminar approach, contralateral sublaminar approach, and paraspinal approach, were reviewed. Outcomes were analyzed in terms of the modified MacNab criteria, Japanese Orthopaedic Association (JOA) score, and visual analogue scale (VAS), with a mean follow-up of 3.1 months. Results: At the final follow-up, the mean VAS for low back pain improved from 4.5±1.0 to 1.2±0.4 and the VAS for leg pain improved from 7.8±0.9 to 1.6±0.5. The mean JOA score improved from 13.5±2.4 to 24.2±2.1. The modified MacNab criteria were excellent in 56 patients (68.3%), good in 22 (26.9%), and fair in 4 (4.8%). In total, 106 levels of LDH were treated. L4–5 disc herniation was performed in 55 patients (51.9%), L5–S1 in 36 (34.0%), L3–4 in 8 (7.5%), L2–3 in 6 (5.7%), and L1–2 in 1 (0.9%). The ipsilateral interlaminar approach was performed in 93 patients (87.7%), the contralateral sublaminar approach in 7 (6.6%), and the paraspinal approach in 6 (5.7%). Operative time significantly improved after performing 20 cases. In the early stage (1–20 cases), the operation time per level was 102.0±28.2 min, while in the next stage (21–82 cases) it was 78.1±20.4 minutes. No serious complications, including cauda equine syndrome or root palsy, were observed. Three patients had dural tears (2.8%), and 1 had epidural hematoma (0.9%). Conclusion: UBE discectomy may be performed safely and effectively for the treatment of LDH in limited-resource settings.