Perioperative and 6-month outcomes of UNSES versus UBE for lumbar disc herniation with standardized annular suture

Unilateral biportal endoscopy (UBE) and uniportal non-coaxial spinal endoscopic surgery (UNSES) are mainstream minimally invasive approaches for lumbar disc herniation (LDH). Few studies have systematically compared their perioperative and medium-term clinical outcomes when all patients receive standardized annulus fibrosus (AF) suture. This retrospective cohort study aimed to compare perioperative indicators and 6-month functional, radiological outcomes between UNSES and UBE in patients with LDH treated with identical annular suture protocols.

The clinical data of 69 patients with LDH admitted between January 2024 and January 2025 were retrospectively analyzed. The patients were divided into the UNSES group (33 cases) and UBE group (36 cases), both undergoing annulus fibrosus suture. Surgical-related indicators, clinical outcomes [low back pain visual analog scale (VAS), radicular leg pain VAS, and Oswestry Disability Index (ODI) scores], radiological parameters (annulus fibrosus closure rate), modified MacNab excellent and good rate, and complications were compared.

The UNSES group of patients had a significantly shorter operation time, less intraoperative blood loss, and lower postoperative C-reactive protein increment than their UBE counterparts (all P < 0.05). No significant differences were found in fluoroscopy times or hospital stay (both P > 0.05). Both patient groups showed significant improvements in VAS and ODI scores postoperatively (all P < 0.05). At 3 and 6 months postoperatively, the UNSES group had significantly lower low back pain VAS and radicular leg pain VAS scores, while the UBE group had a lower ODI score and higher annulus fibrosus closure rate at 6 months (all P < 0.05). The modified MacNab excellent and good rate (93.9% vs. 88.9%) and complication rate (3.03% vs. 8.33%) showed no significant differences (both P > 0.05).

Both UNSES and UBE achieve safe and effective short-term efficacy for LDH when combined with standardized annular suture. UNSES is associated with milder perioperative surgical trauma and sustained lower low back and radicular leg pain within 6 months, whereas UBE yields better 6-month lumbar function scores. Extended 1-2-year longitudinal follow-up and controlled trials without annular repair are required to further investigate whether AF suturing exerts long-term protective effects against disc degeneration and reherniation, which cannot be confirmed by our 6-month short-term data.