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

Abstract

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. Total blood loss (TBL), operation time, hospital stay, complications, total hospitalization costs, clinical efficacy and modified MacNab criteria were collected and evaluated. Percentage of facet joint preservation measured on axial CT scans obtained pre-operation and post-operation. Results The mean follow-up period was 14.07 ± 3.50 months in UBED group, and 14.52 ± 5.37 months in PIED group. The total blood loss and hospitalization cost was more in the UBED Group. The operative time and hospital stay time in the UBED Group was similar with that in PIED Group. The postoperative VAS back, leg scores and ODI score were significantly improved compared with the preoperative scores in both two groups. There was no significant difference in VAS back and leg scores between two groups at 1-day post-operation and final follow-up period. All patients of two groups had similar ODI scores at final follow-up period. The percentage of facet joint preservation is 96.56 ± 9.11% in UBED group, which is significantly less than in PIED group with 99.22 ± 1.52%. One patient in both groups showed postoperative hematoma. A dural tear occurred in UBED group and a never root injury occurred in PIED group. There was no significant difference in patient satisfaction rates between two groups. Conclusion UBED indicates similar clinical effect compared with PIED for treating L5/S1 disc herniation, and there was no significant increase in surgical time or hospital stay. However, more facet joint damage, total blood loss and hospitalization cost may be the disadvantages of UBED technique and need to be taken seriously.