Comparative Outcomes in Single-level Lumbar PIVD Treated with Unilateral Biportal Endoscopic Discectomy versus...

Unilateral biportal endoscopic discectomy (UBE) has emerged as a minimally invasive alternative to microscopic lumbar discectomy (MLD) for the treatment of lumbar disc herniation (LDH). While both techniques effectively decompress nerve roots, UBE is reported to offer benefits such as reduced blood loss and shorter hospital stays (HSs). In contrast, MLD is associated with shorter operative times (OTs) and a gentler learning curve. This study aims to compare the perioperative and clinical outcomes of UBE and MLD, with a particular focus on early postoperative pain relief, functional improvement, surgical efficiency, and complications.

This prospective comparative study included 30 patients with single-level LDH, divided into two groups: 15 underwent UBE, and 15 underwent MLD. Clinical evaluations were performed preoperatively and postoperatively using the Oswestry Disability Index (ODI) and Visual Analog Scale (VAS) at 24 h, 1 week, 2 weeks, 1 month, 3 months, and 6 months. Additional perioperative parameters - OT, estimated blood loss, HS duration, and complication rates - were also recorded and compared between the groups.

Both the groups showed significant improvement in ODI and VAS scores over time, with no notable differences in long-term functional outcomes or complication rates. However, patients in the UBE group experienced significantly better early pain relief, as reflected in lower VAS scores at 24 h (P = 0.001), 1 week (P = 0.002), and 2 weeks (P = 0.041). UBE also resulted in significantly less blood loss (P = 0.001) and shorter HSs (P = 0.005) but had a longer OT (P = 0.002) compared to MLD. The findings suggest that UBE provides superior short-term postoperative benefits, particularly in terms of pain reduction and recovery speed. However, the longer OT and technically demanding nature of the procedure indicate a steeper learning curve, which may influence surgical efficiency and outcomes. Despite these challenges, the advantages in patient recovery position UBE as a compelling alternative to MLD, especially for individuals valuing rapid postoperative improvement.

UBE offers comparable long-term outcomes to MLD with additional advantages in early pain relief, reduced blood loss, and quicker discharge. However, its longer operative duration underscores the need for adequate training and experience. UBE represents a viable minimally invasive surgical option for LDH, with further large-scale, multicenter studies warranted to establish standardized training protocols and refine patient selection strategies.