Skip to main content
JDRS · Open access journal
Joint Diseases and
Related Surgery
Online manuscript submissionSubmit a manuscript e-ISSN 2687-4792

Original Article · Open access

Comparison of unilateral biportal and percutaneous endoscopic discectomy in treating far lateral lumbar disc herniation

PDF Cite this article

Yisong Sun

Department of Orthopaedics, The Second Affiliated Hospital of Anhui Medical University, Hefei, China

ORCID: 0009-0000-2708-2905

Dasheng Tian

Department of Orthopaedics, The Second Affiliated Hospital of Anhui Medical University, Hefei, China

ORCID: 0009-0008-2067-026X

Lei Chen

Department of Orthopaedics, The Second Affiliated Hospital of Anhui Medical University, Hefei, China

ORCID: 0009-0009-2448-0778

Bin Zhu

Department of Orthopaedics, The Second Affiliated Hospital of Anhui Medical University, Hefei, China

ORCID: 0009-0009-9143-8350

Huazhang Zhong

Department of Orthopaedics, The Second Affiliated Hospital of Anhui Medical University, Hefei, China

ORCID: 0009-0009-4884-4804

Juehua Jing

Department of Orthopaedics, The Second Affiliated Hospital of Anhui Medical University, Hefei, China

ORCID: 0009-0000-4622-7401

Abstract

Objectives: This study aims to investigate the clinical efficacy of managing far lateral lumbar disc herniation (FLLDH) through two surgical approaches: unilateral biportal endoscopy (UBE) and percutaneous endoscopic lumbar discectomy (PELD).

Patients and methods: Between December 2019 and September 2024, a total of 45 patients (18 males, 27 females; mean age: 59.76±11.82 years; range, 31 to 89 years) who were diagnosed with FLLDH were retrospectively analyzed. Based on the surgical technique used, the patients were randomly divided into two groups: the PELD group (n=17) and the UBE group (n=28). Perioperative indicators, including operative time, postoperative hospital stay and mean fluoroscopy times, were recorded. Pre- and postoperative assessments were conducted at the time of admission and at one, three, and six months after surgery, using the Visual Analog Scale (VAS) and the Oswestry Disability Index (ODI) scores. The modified MacNab criteria were used to assess patient satisfaction.

Results: Both groups demonstrated a reduction in VAS and ODI scores after surgery (p<0.05). However, no statistically significant differences were observed between the groups at one, three, or six months postoperatively. Operative times were also comparable, with the UBE group mean 97.39±26.78 min and the PELD group 88.18±27.52 min. The postoperative length of hospital stay was similar, with the UBE group staying a mean of 3.93±1.81 days and the PELD group 3.06±1.21 days (p>0.05). The mean fluoroscopy times were significantly lower in the UBE group, with 6.25±1.30 times compared to 16.76±6.02 times in the PELD group (p<0.05).

Conclusion: Our study results suggest that UBE is a viable alternative to PELD for treating FLLDH, offering comparable clinical outcomes with reduced radiation exposure.

Declarations

Author Contributions

Material preparation, data collection and analysis were performed: Y.S., D.T., L.C., H.Z.; The first draft of the manuscript was written: Y.S.; The final draft of the manuscript was reviewed: J.J. All authors read and approved the final manuscript. All authors contributed to the study conception and design.

Conflict of Interest

The authors declared no conflicts of interest with respect to the authorship and/or publication of this article.

Financial Disclosure

The authors received no financial support for the research and/or authorship of this article.

Data Sharing Statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.

References

  1. Berra LV, Di Rita A, Longhitano F, Mailland E, Reganati P, Frati A, et al. Far lateral lumbar disc herniation part 1: Imaging, neurophysiology and clinical features. World J Orthop 2021;12:961-9. DOI: 10.5312/wjo.v12.i12.961.
  2. Lin L, Ke ZY, Chu L, Cheng Y, Zhao GS, Zhong D, et al. Full-endoscopic lumbar discectomy via lateral superior articular process approach for treating far lateral lumbar disc herniation: A retrospective study and technical note. Int Orthop 2023;47:2843-50. DOI: 10.1007/s00264-023-05937-0.
  3. Greil ME, Ogunlade JI, Bergquist J, Williams JR, Kashlan ON, Hofstetter CP. Full-endoscopic trans-pars interarticularis approach for far lateral lumbar discectomy. Eur Spine J 2023;32:2709-16. DOI: 10.1007/s00586-023-07698-1.
  4. Serifoglu L, Etli MU. Transforaminal epidural injection for far lateral lumbar disc herniations: An alternative to surgery or just a delay? Cureus 2024;16:e52530. DOI: 10.7759/cureus.52530.
  5. Connolly J, Borja AJ, Kvint S, Glauser G, Strouz K, McClintock SD, et al. Postoperative outcomes and resource utilization following open vs endoscopic far lateral lumbar discectomy. Int J Spine Surg 2023;17:350-5. DOI: 10.14444/8443.
  6. Kaya M, Keskin E, Ceylan D, Kacira T, Kitiki Kacira Ö. Surgical treatment of far lateral lumbar disc herniation: Outcomes of the safe and simple midline approach. Cureus 2022;14:e27907. DOI: 10.7759/cureus.27907.
  7. Jarebi M, Awaf A, Lefranc M, Peltier J. A matched comparison of outcomes between percutaneous endoscopic lumbar discectomy and open lumbar microdiscectomy for the treatment of lumbar disc herniation: A 2-year retrospective cohort study. Spine J 2021;21:114-21. DOI: 10.1016/j.spinee.2020.07.005.
  8. Liu JW, Li SX, Wang F, Yang Y, Yu H. Hidden blood loss in percutaneous endoscopic lumbar discectomy via the posterolateral approach. Jt Dis Relat Surg 2025;36:56-64. DOI: 10.52312/jdrs.2025.2065.
  9. Odent JB, Castel X, Vieira TD, Brahim EB, Fière V, d'Astorg H, et al. Beyond traditional surgery for far lateral lumbar herniation: Transforaminal full endoscopic discectomy. Neurochirurgie 2025;71:101620. DOI: 10.1016/j.neuchi.2024.101620.
  10. Zhiqiang Z, Jiandong Y, Zhi H, Mohamed AA, Liang Z, Xinmin F. Clinical efficacy of biportal versus uniportal endoscopic discectomy for far lateral lumbar disc herniation: A retrospective study analysis. World Neurosurg 2025;197:123788. DOI: 10.1016/j.wneu.2025.123788.
  11. Chun EH, Park HS. A modified approach of Percutaneous Endoscopic Lumbar Discectomy (PELD) for far lateral disc herniation at L5-S1 with foot drop. Korean J Pain 2016;29:57- 61. DOI: 10.3344/kjp.2016.29.1.57.
  12. Wu CY, Huang HM, Lee HC, Tang CH, Chen YH, Chiu CD. Transforaminal unilateral biportal endoscopic spinal surgery for extraforaminal lumbar disc herniation: A retrospective observational study. World Neurosurg 2024;183:e658-67. DOI: 10.1016/j.wneu.2023.12.162.
  13. Park DK, Weng C, Zakko P, Choi DJ. Unilateral biportal endoscopy for lumbar spinal stenosis and lumbar disc herniation. JBJS Essent Surg Tech 2023;13:e22.00020. DOI: 10.2106/JBJS.ST.22.00020.
  14. Pan M, Li Q, Li S, Mao H, Meng B, Zhou F, et al. Percutaneous endoscopic lumbar discectomy: Indications and complications. Pain Physician 2020;23:49-56.
  15. Qiao X, Yan L, Feng Y, Li X, Zhang K, Lv Z, et al. Efficacy and safety of corticosteroids, hyaluronic acid, and PRP and combination therapy for knee osteoarthritis: A systematic review and network meta-analysis. BMC Musculoskelet Disord 2023;24:926. DOI: 10.1186/s12891-023-06925-6.
  16. Pennings JS, Devin CJ, Khan I, Bydon M, Asher AL, Archer KR. Prediction of Oswestry Disability Index (ODI) using PROMIS-29 in a national sample of lumbar spine surgery patients. Qual Life Res 2019;28:2839-50. DOI: 10.1007/s11136-019-02223-8.
  17. Yu L, Dong H, Tan H, Xie X, Liu N, Zhang G, et al. Uniportal full-endoscopic foraminotomy for lumbar foraminal stenosis: Clinical characteristics and functional outcomes. Orthop Surg 2024;16:1861-70. DOI: 10.1111/os.14102.
  18. Cui H, Ye Y, Liu A. Letter to the editor regarding: “Transforaminal unilateral biportal endoscopic spinal surgery for extraforaminal lumbar disc herniation: A retrospective observational study”. World Neurosurg 2024;191:335. DOI: 10.1016/j.wneu.2024.07.115.
  19. Ahuja S, Moideen AN, Dudhniwala AG, Karatsis E, Papadakis L, Varitis E. Lumbar stability following graded unilateral and bilateral facetectomy: A finite element model study. Clin Biomech (Bristol) 2020;75:105011. DOI: 10.1016/j.clinbiomech.2020.105011.
  20. Tang K, Goldman S, Avrumova F, Lebl DR. Background, techniques, applications, current trends, and future directions of minimally invasive endoscopic spine surgery: A review of literature. World J Orthop 2023;14:197-206. DOI: 10.5312/wjo.v14.i4.197.
  21. Van Isseldyk F, Padilla-Lichtenberger F, Guiroy A, Asghar J, Quillo-Olvera J, Quillo-Reséndiz J, et al. Endoscopic treatment of lumbar degenerative disc disease: A narrative review of full-endoscopic and unilateral biportal endoscopic spine surgery. World Neurosurg 2024;188:e93-107. DOI: 10.1016/j.wneu.2024.05.047.
  22. Leyendecker J, Prasse T, Rückels P, Köster M, Rumswinkel L, Schunk V, et al. Full-endoscopic spine-surgery in the elderly and patients with comorbidities. Sci Rep 2024;14:29188. DOI: 10.1038/s41598-024-80235-2.
  23. Heo DH, Kim JY, Park JY, Kim JS, Kim HS, Roh J, et al. Clinical experiences of 3-dimensional biportal endoscopic spine surgery for lumbar degenerative disease. Oper Neurosurg 2022;22:231-8. DOI: 10.1227/ONS.0000000000000090.
  24. Wang Z, Wen J, Ren C, Xue W, Song Y, Liu L. Anterior endoscopy combining with modified total en block spondylectomy for synovial sarcoma in thoracic paraspine causing neurological deficits: Case report and literature review. Orthop Surg 2022;14:2776-81. DOI: 10.1111/os.13389.
  25. Park JH, Jung JT, Lee SJ. How i do it: L5/S1 foraminal stenosis and far-lateral lumbar disc herniation with unilateral bi-portal endoscopy. Acta Neurochir (Wien) 2018;160:1899- 903. DOI: 10.1007/s00701-018-3630-9.
  26. Zheng B, Xu S, Guo C, Jin L, Liu C, Liu H. Efficacy and safety of unilateral biportal endoscopy versus other spine surgery: A systematic review and meta-analysis. Front Surg 2022;9:911914. DOI: 10.3389/fsurg.2022.911914.
  27. Ma X, Li W, Gao S, Cao C, Li C, He L, et al. Comparison of unilateral biportal endoscopic discectomy versus percutaneous endoscopic lumbar discectomy for the treatment of lumbar disc herniation: A systematic review and meta-analysis. Medicine (Baltimore) 2022;101:e30412. DOI: 10.1097/MD.0000000000030612.
  28. Liu SX, Chen RS, Chen CM, He LR, Jhang SW, Lin GX. Unilateral biportal endoscopic spine surgery: A meta-analysis unveiling the learning curve and clinical benefits. Front Surg 2024;11:1405519. DOI: 10.3389/fsurg.2024.1405519.
  29. Sun B, Wu H, Xu Z, Lu J, Wang Y, Zhang K, et al. Is selective nerve root block necessary for learning percutaneous endoscopic lumbar discectomy: A comparative study using a cumulative summation test for learning curve. Int Orthop 2020;44:1367-74. DOI: 10.1007/s00264-020-04558-1.
  30. Kang MS, Hwang JY, Park SM, Yang JH, You KH, Hong SH, et al. Comparison of biportal endoscopic and microscopic tubular paraspinal approach for foraminal and extraforaminal lumbar disc herniation. J Neurosurg Spine 2024;41:473-82. DOI: 10.3171/2024.4.SPINE23707.
  31. Qian J, Lv X, Luo Y, Liu Y, Jiang W. Unilateral biportal endoscopic discectomy versus percutaneous endoscopic lumbar discectomy in the treatment of lumbar disc herniation linked with posterior ring apophysis separation: A retrospective study. World Neurosurg 2025;193:957-63. DOI: 10.1016/j.wneu.2024.09.102.
  32. Ren Z, He S, Li J, Wang Y, Lai J, Sun Z, et al. Comparison of the safety and effectiveness of percutaneous endoscopic lumbar discectomy for treating lumbar disc herniation under epidural anesthesia and general anesthesia. Neurospine 2020;17:254-9. DOI: 10.14245/ns.1938366.183.
  33. Gadjradj PS, Arjun Sharma JRJ, Harhangi BS. Quality of conscious sedation using dexmedetomidine during full-endoscopic transforaminal discectomy for sciatica: A prospective case series. Acta Neurochir (Wien) 2022;164:1209-16. DOI: 10.1007/s00701-021-05100-x.
  34. Merter A, Karaeminogullari O, Shibayama M. Comparison of radiation exposure among 3 different endoscopic diskectomy techniques for lumbar disk herniation. World Neurosurg 2020;139:e572-9. DOI: 10.1016/j.wneu.2020.04.079.
  35. Gu N, Zhang J, Liu A. Letter to the editor regarding "Comparative study between unilateral biportal endoscopic discectomy and percutaneous interlaminar endoscopic discectomy for the treatment of L5/S1 disc herniation". World Neurosurg 2025;195:123650. DOI: 10.1016/j.wneu.2024.123650.