Efficacy and safety of unilateral biportal endoscopy vs. percutaneous endoscopic interlaminar approach in lumbar disc...

Lumbar disc herniation (LDH) is a common cause of lower back and radicular pain. Unilateral biportal endoscopic discectomy (UBE) and percutaneous endoscopic interlaminar discectomy (PEID) are two prevalent minimally invasive techniques, yet their comparative efficacy and safety remain debated. Within the present meta-analysis, the aim was to compare the efficacy and safety of UBE and PEID in treating LDH. A systematic literature search was conducted using Web of Science, PubMed, Embase and the Cochrane Library up to June 10, 2025, to identify comparative studies evaluating UBE and PEID for single-level LDH. Extracted data included operative time, blood loss, fluoroscopy frequency, hospital stay, visual analog scale (VAS) score for back and leg pain, Oswestry Disability Index (ODI), MacNab excellent/good rate and complication rate. Study quality was assessed using the Newcastle-Ottawa Scale. A total of ten studies involving 1,003 patients was included. PEID demonstrated advantages in operative time [mean difference (MD)=7.82 min; P=0.004], blood loss (MD=25.5 ml; P=0.01) and hospital stay (MD=0.56 days; P=0.007). UBE demonstrated ODI improvement at 1 (MD=-0.93; P=0.01) and 6 months (MD=-0.85; P=0.01). No significant differences were observed in VAS scores for back and leg pain, MacNab excellent/good rate, fluoroscopy frequency or complication rates. UBE demonstrated improved postoperative functional recovery, instrument maneuverability and visualization, whereas PEID offered shorter operative time, reduced blood loss and shorter hospital stays. The choice of surgical approach should consider these outcome trade-offs along with patient characteristics and surgeon expertise.