Unilateral biportal endoscopy for upper lumbar disc herniation: surgical challenges and clinical outcomes

Upper lumbar disc herniation (ULDH) is a rare type of herniation occurring at the L1/L2 or L2/L3 level. Due to its high location, associated with small spinal canal volume and complex anatomy, surgical treatment of this condition is challenging.

The aim of this study was to evaluate the clinical efficacy of unilateral biportal endoscopy (UBE) in the treatment of ULDH, and to assess short-term clinical outcomes.

This was a retrospective analysis of patients with L1/L2 or L2/L3 LDH who underwent UBE decompression surgery between June 2021 and June 2024 at the Department of Orthopedics of the Beijing Friendship Hospital. Demographic characteristics and surgical data were analyzed, and the Oswestry Disability Index (ODI), Japanese Orthopaedic Association (JOA), and visual analog scale (VAS) scores for lower back and leg pain were collected from the patients preoperatively, postoperatively, and at the final follow-up. Clinical improvement was assessed using the MacNab criteria.

During the study period, a total of 18 patients with ULDH who met the inclusion criteria underwent UBE decompression surgery. The mean (SD) follow-up was 17.5 (9.2) months. Postoperative VAS, JOA, and ODI scores showed significant improvement, as compared with the preoperative values, whereas the values obtained at the final follow-up did not differ significantly from those recorded in the early postoperative period. Only 1 patient showed poor improvement and developed postoperative complications.

UBE technology has significant potential in the field of ULDH treatment; however, further large-scale clinical trials are warranted to confirm its long-term efficacy.