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Updated: Jun 21, 2026
The Third Channel-Assisted Unilateral Biportal Endoscopic Technique for Lumbar Spinal Stenosis Combined with Contralateral Disc Herniation
Published on: November 17, 2023
Unilateral Biportal Endoscopic Discectomy vs Percutaneous Interlaminar Endoscopic Discectomy for L5 to S1 Disc
Guanyi Liu1,2, Zihui Yang3, Qing Li4
1Department of Spine Surgery Center, Ningbo No. 6 Hospital, Ningbo, China.
Objective:
To compare the clinical efficacy and perioperative outcomes of percutaneous interlaminar endoscopic discectomy (PIED) and unilateral biportal endoscopic discectomy (UBED) in treating L5 to S1 lumbar disc herniation.
Methods:
This prospective comparative study with quasirandom allocation included 59 patients with diagnosed isolated L5 to S1 disc herniation who underwent either PIED (n = 30) or UBED (n = 29) between January 2023 and June 2024. Surgical time, drain placement duration, drainage volume, postoperative hospitalization duration, visual analog scale (VAS) scores for low back and leg pain, and Oswestry Disability Index (ODI) scores were recorded pre- and postoperatively. Clinical outcomes were assessed using the modified MacNab criteria at the final follow-up.
Results:
Both PIED and UBED groups demonstrated significant postoperative improvements in lumbar and leg pain VAS scores and ODI scores (P < 0.001). The PIED group showed significantly shorter operative time (58.2 ± 3.1 minutes vs 109.6 ± 4.3 minutes, P < 0.001) and hospital stay (1.0 ± 0.2 days vs 3.1 ± 0.8 days, P < 0.001) compared with the UBED group. Additionally, the PIED group had lower lumbar pain VAS scores at final follow-up (0.6 ± 0.6 vs 1.2 ± 0.9, P < 0.05). No postoperative drainage was required in the PIED group, while the UBED group required a mean drain duration of 2.7 ± 0.7 days with a mean output of 71.6 ± 38.3 mL. No significant differences were observed in final ODI scores or overall clinical outcomes based on the modified MacNab criteria (96.6% vs 86.2%, P = 0.297).
Conclusion:
Both UBED and PIED are safe and effective techniques for treating L5 to S1 disc herniation. However, PIED is associated with shorter operative time, faster postoperative recovery, and less early postoperative lumbar pain. These findings support the preferential use of PIED in selected patients with isolated L5 to S1 disc herniation.
Clinical Relevance:
This study provides comparative evidence to guide surgical decision-making for L5-S1 disc herniation. The advantages of PIED-including reduced operative duration, accelerated recovery, and decreased early postoperative pain-may translate into improved patient satisfaction, reduced healthcare resource utilization, and earlier return to daily activities or work. Surgeons can consider PIED as a favorable minimally invasive option for appropriately selected patients.