Comparison of Clinical Outcomes and Muscle Invasiveness between Unilateral Biportal Endoscopic Discectomy and Percutaneous Endoscopic Interlaminar Discectomy for Lumbar Disc Herniation at L5/S1 Level

Abstract

Objective Both unilateral biportal endoscopic discectomy (UBED) and percutaneous endoscopic interlaminar discectomy (PEID) could achieve favorable outcomes for lumbar disc herniation (LDH). There are limited studies comparing the two different methods of endoscopic discectomy. The objective was to comprehensively compare the clinical outcome and muscle invasiveness of UBED and PEID for the treatment of LDH at L5/S1 level with at least 1‐year follow‐up. Methods The retrospective cohort study enrolled 106 LDH patients of L5/S1 level from January 2018 to December 2020. There were 51 patients who underwent UBED (22 males and 29 females, 43.8 ± 14.2 years old) and 55 patients underwent PEID (28 males and 27 females, 42.3 ± 13.8 years old). Clinical outcomes and surgical invasiveness were compared between the two groups for at least 1 year follow‐up. Clinical outcomes included visual analogue scale (VAS) scores, Oswestry Disability Index (ODI), complications, recurrence of LDH, intraoperative anesthesia time, operative time, number of intraoperative fluoroscopies, and postoperative length of stay. Surgical invasiveness was evaluated with serum CPK level and change rate of lean multifidus cross‐sectional area (LMCSA). Independent‐sample t test and paired sample t test were used to compare continuous data. Chi‐square test and Fisher's precision probability tests were used to analyze the categorical data. Results Both groups achieved favorable clinical outcomes at the last follow‐up, including VAS and ODI (all Ps <0.05). The intraoperative anesthesia time for UBED was longer, but with no difference of operative time. As for intraoperative fluoroscopy times (2.5 vs 2.4), postoperative length of stay (2.1 vs 2.0 days), postoperative complications (5.9% vs 3.6%), there were also no significant difference. The serum CPK level and change rate of LMCSA for UBED was higher than PEID at postoperative 1st day. At the last follow‐up, there was no significant difference in the change rate of LMCSA between the two groups (P = 0.096). Conclusions Both UBED and PEID could achieve favorable clinical outcomes for the treatment of L5/S1 LDH. Despite UBED is more invasive, the radiological manifestation of paraspinal muscle invasiveness was equal at last follow‐up with at least 1 year. UBED is a safe and innovative alternative choice for treatment of LDH at L5/S1 level.

Is unilateral biportal endoscopic discectomy superior to percutaneous interlaminar endoscopic discectomy in the treatment of L5/S1 disc herniation? A retrospective study

“…While muscle-bone separation using the electrical coagulator on the surface of the vertebral lamina, UBED requires a larger range of muscle and soft tissue dissection to obtain greater operating space. Wang L et al [23] indicated the serum CPK level and change rate of lean multi dus crosssectional area (LMCSA) for UBED was obviously higher than PIED at postoperative 1st day. Unlike PIED surgical instruments only used in work channel, various surgical instruments repeatedly enter and exit the surgical area through skin incisions during the operation of UBED, which can easily damage intermuscular blood vessels and cause bleeding.…”

“…From the introduction of UBE technique to its widespread and exible application, it has been proven by many scholars to be safe, effective, and e cient in dealing with cervical, thoracic, lumbar degenerative diseases, and even revision surgery [8][9][10][11] . Although UBE technique provides a broader surgical eld of view and more exible surgical procedures, the accompanying more paraspinal muscle injuries and corresponding hidden blood loss also need to be given su cient attention [12,13] .…”

Title：Percutaneous endoscopic interlaminar discectomy versus unilateral biportal endoscopy in the treatment of L5/S1 degeneration disease: a randomized controlled trial

“…With the innovation and development of full endoscopic systems [6][7] , spinal endoscopy technology has developed into a safe, effective 8 and e cient 9 alternative to minimally invasive spinal surgery, making it possible for orthopedic surgeons to perform precise decompression surgery through the selection of different approaches 10 . At present, the main minimally invasive endoscopic techniques for the treatment of LDD 11 include percutaneous single-channel interlaminar spinal endoscopy discectomy (PEID) and transforaminal percutaneous endoscopic lumber discectomy,TF-PELD) and unilateral biportal endoscopy (UBE) 12 have been demonstrated in many clinical studies and meta-analyses to be effective and safe [13][14][15][16][17] .…”