Comparison of clinical efficacy of unilateral biportal endoscopic discectomy and percutaneous endoscopic interlaminar discectomy in the treatment of lumbar disc herniation at different segments.

Abstract

Objective: To compare outcomes of unilateral biportal endoscopic discectomy (UBED) and percutaneous endoscopic interlaminar discectomy (PEID) for lumbar disc herniation (LDH) at L3-S1 levels, aiming to identify the optimal segment-specific approach given anatomical variations between laminae.

Methods: A retrospective analysis of 210 LDH patients was conducted (UBED: n = 102 [L3/4 = 22, L4/5 = 42, L5/S1 = 38]; PEID: n = 108 [L3/4 = 16, L4/5 = 47, L5/S1 = 45]). Both groups had a follow-up period of more than six months. Assessed parameters included: intraoperative blood loss, postoperative hemoglobin loss, surgical duration, incision length, drainage volume, hospital stay, costs, VAS (back/leg pain at 3d/1m/6m), ODI, and modified MacNab criteria.

Results: Both groups showed significant postoperative improvement in VAS and ODI scores. Overall, UBED had larger incisions, greater drainage volume, higher costs, and longer hospital stays than PEID. For L4/5 and L5/S1 LDH, UBED resulted in more intraoperative blood loss, greater hemoglobin loss, and longer surgical duration. Conversely, for L3/4 LDH, UBED had significantly shorter surgical time. No significant differences existed in 6-months postoperative complications or MacNab scores.

Conclusions: UBED and PEID both achieve good clinical outcomes. PEID demonstrates significant advantages for L4/5 and L5/S1 LDH, offering less bleeding and shorter surgical time. UBED is advantageous for L3/4 LDH due to shorter surgical duration. PEID also allows omission of drainage tubes due to minimal postoperative drainage.