Comparative Study Between Unilateral Biportal Endoscopic Discectomy and Percutaneous Interlaminar Endoscopic Discectomy for the Treatment of L5/S1 Disc Herniation

Purpose: To compare the clinical outcomes of unilateral biportal endoscopic discectomy (UBED) and percutaneous interlaminar endoscopic discectomy (PIED) for treating L5/S1 disc herniation.

Methods: Patients with L5/S1 disc herniation treated with UBED (n = 46) and PIED (n = 50) in our hospital during the same period were retrospectively reviewed. Clinical outcome, radiographic parameters, and complications of each group were collected and evaluated.

Results: The mean follow-up period was 14.11 ± 3.47 months in the UBED group and 14.52 ± 5.37 months in the PIED group. There was no significant difference in visual analog scale score for the leg (P = 0.836) or lumbar scores (P = 0.335) between PIED and UBED group at preoperative, 1-day postoperative, and last follow-up point. Within the same group, there were significant differences in visual analog scale score for the leg (P < 0.001) and lumbar scores (P < 0.001) compared pairwise at 3 time points. Oswestry Disability Index scores of both groups showed significant improvement at the last follow-up (P < 0.001, P < 0.001), and there was no significant difference in patient satisfaction rates (97.8% vs. 96%) between the 2 groups on the basis of the MacNab criteria. The percentage of facet joint preservation was 96.74 ± 9.10% in the UBED group and 99.22 ± 1.52% in the PIED group. The total blood loss and hospitalization cost was greater in the UBED group. One patient in both groups showed postoperative hematoma. A dural tear occurred in UBED group and a never root injury occurred in the PIED group.

Conclusions: UBED indicates similar short-term efficacy compared with PIED for treating L5/S1 disc herniation. No difference was found in facet joint preservation between the 2 groups. We believe the increased cost of UBED as the result of surgical consumables will decrease in the future.