Comparison of clinical efficacy and facet joint invasiveness between unilateral biportal endoscopic and percutaneous endoscopic lumbar discectomy treatment of calcified lumbar disc herniation: a retrospective analysis

Comparison of clinical efficacy and facet joint invasiveness between unilateral biportal endoscopic and percutaneous endoscopic lumbar discectomy treatment of calcified lumbar disc herniation: a retrospective analysis | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Comparison of clinical efficacy and facet joint invasiveness between unilateral biportal endoscopic and percutaneous endoscopic lumbar discectomy treatment of calcified lumbar disc herniation: a retrospective analysis Zhifeng Cheng, Tao Tang, Qiang Wu, Likan Liang, Zhijun Chen, Jiafeng Hong, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8027015/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Comparing the clinical efficacy and lumbar facet invasiveness of percutaneous endoscopic lumbar discectomy (PELD) and unilateral biportal endoscopic (UBE) treatment for calcified lumbar disc herniation (CLDH), providing new ideas for spinal surgeons to treat CLDH. Methods A retrospective analysis was conducted on the data of 49 CLDH patients who underwent intervertebral disc resection surgery in our hospital from January 2016 to August 2024, including 20 who underwent PELD surgery and 29 who underwent UBE surgery. The demographic, clinical, and surgical outcomes of the two groups of patients were collected and analyzed. Results All surgeries were completed successfully, with significant improvement in clinical symptoms observed in both groups postoperatively. The PELD group required an average of 5.52 more fluoroscopy frequency than the UBE group. The average operative time in the PELD group was 9.21 minutes shorter than in the UBE group. The mean pre-to-postoperative hemoglobin difference was 3.65 g/L lower in the PELD group than in the UBE group. The mean preservation rate of Lumbar Facet was 9.10% higher in the PELD group than in the UBE group. These differences were statistically significant (P < 0.05). The excellent-to-good rate was 90.00% in the PELD group and 93.10% in the UBE group. Additionally, two patients in the PELD group experienced complications, and two patients had recurrence at 12 months postoperatively; however, none resulted in severe consequences. No complications or postoperative recurrences were observed in the UBE group. Conclusions Both PELD and UBE are effective methods for the treatment of CLDH, but the surgical approach should be selected based on the actual conditions of patients. For patients with complex disc calcification, UBE is recommended. Calcified lumbar disc herniation Unilateral biportal endoscopy percutaneous endoscopic lumbar discectomy facet joint clinical efficacy invasion Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Introduction Calcified lumbar disc herniation (CLDH), a variant of lumbar disc herniation (LDH), is a more complex condition characterized by concurrent disc herniation and calcification [ 1 ]. It has been reported in the literature that its incidence ranges from 4.7% to 15.9% [ 2 – 3 ]. The main symptoms of CLDH include lower limb pain, numbness, weakness, and bladder dysfunction [ 4 ]. In the process of calcification, the intervertebral disc may adhere to the peripheral nerve and dural sac, which will lead to the tear of dural sac, leakage of cerebrospinal fluid and peripheral nerve injury more easily [ 5 ]. So the treatment of CLDH is different from that of LDH. When conservative treatment is ineffective for a period of time or has seriously affected the daily life of patients, surgical treatment should be sought [ 6 ]. Open surgery is the standard surgical procedure for the treatment of CLDH [ 7 ], but due to the large trauma, large blood loss, slow postoperative recovery, and even muscle atrophy [ 8 ], people are constantly looking for new technologies to replace the traditional open surgery. Percutaneous endoscopic lumbar discectomy (PELD) is a minimally invasive surgical method for the treatment of LDH, which is characterized by small incision, minimal intraoperative bleeding, short hospital stays, and even ambulatory surgery, making it more and more widely used in LDH surgery [ 9 ]. Recently, PELD has also been reported to treat CLDH, and the outcome is satisfactory [ 10 – 11 ]. However, due to a single observation and working channel, the flexibility of PELD is greatly reduced, and CLDH mostly has adhesion to the peripheral nerve and dural sac, which is prone to complications such as nerve root injury and dural tear [ 12 ]. We reviewed relevant reports showing that the incidence of complications of PELD in the treatment of CLDH is 2.0% − 12.9% [ 11 , 13 – 17 ], which requires surgeons to have rich experience to avoid neurological complications [ 18 ]. Unilateral biportal endoscopic (UBE) is a new surgical method, and its separate observation and operation channels greatly make up for the shortcomings of PELD [ 19 ]; Recently, many studies have reported that UBE has achieved good results in the treatment of various types of LDH [ 20 – 21 ]. Our aim is to compare the clinical efficacy and radiographic outcomes of PELD and UBE in the treatment of CLDH, so as to provide a new idea for spine surgeons in the treatment of CLDH. Materials and Methods This study is a single center, non randomized, retrospective case-control study. The data of 49 CLDH patients who underwent PELD and UBE surgery in Jiangxi Provincial Hospital of Integrated Traditional Chinese and Western Medicine from January 2016 to August 2024 were collected and analyzed. They were divided into PELD group (20 patients) and UBE group (29 patients). The demographic, clinical outcomes and surgery related clinical data were collected. Inclusion Criteria (1) Patients with LDH confirmed by magnetic resonance imaging (MRI) and CLDH verified by computed tomography (CT);(2) Patients with lower limb pain and numbness who showed no response to standard conservative treatment for 6 months;(3) Patients with single-segment CLDH symptoms who agreed to undergo PELD or UBE;(4) Patients with complete clinical data;(5) Patients who completed follow-up for more than 12 months. Exclusion Criteria (1) Patients with other types of LDH without calcification or with calcification involving multiple segments;(2) Patients with lumbar spondylolisthesis, scoliosis, lumbar tumors, lumbar infections, or ankylosing spondylitis;(3) Patients with single-segment or multi-segment lumbar instability (defined as > 3 mm translational displacement or > 5° angular change); (4) Patients with severe underlying diseases who could not tolerate anesthesia; (5) Patients with a follow-up duration of less than 1 year. Ethical Approval This study was approved by the Ethics Committee of Jiangxi Provincial Hospital of Integrated Traditional Chinese and Western Medicine and complied with the ethical standards outlined in the Declaration of Helsinki . All patients who underwent surgery signed an informed consent form for clinical research. Demographic, clinical outcome, and surgical information collection Collect demographic characteristics including age (years), gender (male/female), body mass index (BMI, kg/m²), and follow-up duration (months). Record surgery-related parameters including: length of hospital stay (days), surgical segment, fluoroscopy frequency (times), operative time (minutes), pre- and post-operative hemoglobin difference (g/L), and lumbar facet preservation rate (%).Clinical outcomes included visual analog scale (VAS) scores [22] for low back pain and leg pain at preoperative, day 1 postoperatively, 1 month postoperatively, 6 months postoperatively, and 12 months postoperatively; Oswestry Disability Index (ODI) [23] scores at preoperative and 12 months postoperatively; modified MacNab scores [24] at the final follow-up; surgical complications; and recurrence at 1 year postoperatively. Lumbar CT scans were rechecked on the 3rd postoperative day. The facet joint retention rate at the surgical segment was calculated using axial CT views. Taking the L5/S1 segment as an example, the calculation method referred to [25]: Preoperative axial length of the middle facet joint (A) and postoperative axial length of the same facet joint (B), with the facet joint preservation rate calculated as B/A (Figure 1). The modified MacNab criteria are as follows: Excellent (100% resolution of clinical symptoms at 1 year postoperatively); Good (50–99% resolution of clinical symptoms at 1 year postoperatively); Fair (1–49% resolution of clinical symptoms at 1 year postoperatively); Poor (0% resolution or worsening of clinical symptoms at 1 year postoperatively). Figure 1 A:Preoperative axial length of the middle facet joint; B:postoperative axial length of the same facet joint; facet joint preservation rate calculated as B/A. Surgery UBE The all procedures were performed by an experienced spine surgeon, B.H. The patient was positioned prone. Following successful induction of general anesthesia, the target intervertebral space and working channel were identified under C-arm fluoroscopy. The working channel was located approximately 1 cm lateral to the junction of the spinous process and lamina. and the viewing channel was established 3 cm above or below the working channel. Two skin incisions (each 0.8–1.5 cm in length) were made at the sites of the working and viewing channels. Soft tissues were gradually dilated using dilators, followed by insertion of surgical instruments and the endoscope. Radiofrequency ablation was used to coagulate soft tissues and create a working space. A high-speed burr, osteotome, and rongeur were employed to remove parts of the lamina and superior/inferior articular processes, ensuring adequate exposure of the cephalad and caudal ligamentum flavum. A portion of the ligamentum flavum was resected to expose and mobilize the traversing and exiting roots of the target nerve. The herniated calcified nucleus pulposus was then removed, and the annulus fibrosus was sutured to prevent postoperative recurrence. Intraoperative dural sac injury was managed as follows: minor injuries did not require special treatment, but a second operation was performed if persistent cerebrospinal fluid leakage occurred postoperatively; for major injuries, an open surgical repair of the dura was performed directly. Finally, the incisions were sutured to complete the surgery (Figure 2). Figure 2 An 89 year old male patient had low back pain with leg pain in both lower limbs for more than 20 years, and had radiating pain, numbness and fatigue in both lower limbs in recent 20 days; The straight leg raising test of both lower limbs was positive, and the muscle strength of both lower limbs was grade 4. Lumbar magnetic resonance showed lumbar 4-5 intervertebral disc herniation, ligamentum flavum hypertrophy, and spinal canal stenosis (white circles in Figure A and B); CT of the lumbar spine showed herniation and calcification of the intervertebral disc and ossification of the ligamentum flavum of the lumbar spine (black circles in Figure C and D). We performed UBE for him. The postoperative patients felt that the low back pain was significantly improved compared with that before operation, and the radiating pain, numbness and fatigue of both lower limbs were significantly improved compared with that before operation; Postoperative reexamination of lumbar CT showed that the herniated and calcified intervertebral discs were basically removed, and the ossified ligamentum flavum was basically removed (Fig. F and G). We performed pathological examination of the nucleus pulposus, suggesting the presence of dead bone tissue in the nucleus pulposus. PELD All PELD procedures were conducted by the same experienced spine surgeon (Surgeon T.T.). Thirty minutes before surgery, patients received 8 mg lornoxicam for injection (a non-steroidal anti-inflammatory drug) for pain relief. The transforaminal approach was adopted: patients were placed in the lateral decubitus position, and the surgical site was confirmed under C-arm fluoroscopy. The surgeon administered local infiltration anesthesia using an 18G needle with an appropriate volume of 1% lidocaine, and patients remained awake throughout the entire procedure. A single skin incision (0.8–1.5 cm in length) was made, and soft tissues were gradually dilated with dilators before inserting the endoscope and surgical instruments. If the intervertebral foramen was found to be too narrow during the operation, a rongeur was used to resect part of the bone to ensure the smooth progression of the surgery.Subsequently, nerve root decompression was performed, and the herniated calcified intervertebral disc was carefully removed. Intraoperative dural sac injury was managed using the same protocol as in UBE surgery. After completion of decompression, the incision was sutured to finish the surgery (Figure 3). Figure 3 A 29 year old male patient had low back pain with radiating pain of the right lower limb for 1 year, which aggravated for 10 days. The right straight leg elevation test was positive, and the muscle strength of both lower limbs was normal. MRI revealed that the L5-S1 intervertebral disc protruded to the right side and compressed the nerve root; CT of lumbar spine showed calcification of intervertebral disc; We performed PELD for him, and the symptoms of the patient's right lower limb disappeared and the low back pain was significantly relieved after the operation. Perioperative Management Postoperatively, patients received general symptomatic treatment including analgesia. They were instructed to perform in-bed muscle contraction exercises to prevent complications (e.g., lower extremity deep vein thrombosis). Based on individual patient conditions, early ambulation was encouraged with the use of a customized lumbar brace, typically starting on the 2nd postoperative day. On the 3rd postoperative day, patients underwent lumbar X-ray, computed tomography scan, and lumbar MRI examinations. If the postoperative reexamination results were satisfactory, patients were generally permitted to be discharged on the 4th postoperative day. Statistical Analysis Data were processed using SPSS 26.0 statistical software. We first conducted normality tests on continuous data. For data meeting normal distribution criteria, analysis was performed using the independent samples t-test, with results expressed as mean ± standard deviation. For data not meeting normal distribution criteria, For categorical data, the Kruskal-Wallis test was applied; categorical data were analyzed using the chi-square test or Fisher's exact test. A p-value < 0.05 was considered statistically significant. Results Demographic and Surgical Outcomes Throughout the process, 55 patients with calcified disc herniation underwent PELD or UBE surgery. Among them, 3 patients were lost to follow-up, and 3 patients lacked complete imaging data. Ultimately, 49 patients were included in this study: 20 patients underwent PELD surgery, and 29 patients underwent UBE surgery. There were no significant differences between the two groups in age, gender, BMI, or follow-up duration (p > 0.05) (Table 1). Hospital Stay and surgical segment showed no significant differences between groups (p > 0.05). Significant differences were observed in fluoroscopy frequency, operative time, pre- and postoperative hemoglobin difference, and lumbar facet preservation rate (p < 0.05). PELD required an average of 5.52 more fluoroscopy frequency than UBE. PELD operative time was 9.21 minutes shorter than UBE. The mean pre- and postoperative hemoglobin difference was 3.65 g/L lower in PELD than in UBE. The lumbar facet preservation rate was 9.10% higher in PELD than in UBE (Table 1, Figure 4). Table 1 Comparison of basic demographic information and surgical indicators of patients PELD（N = 20 ) UBE（N = 29 ) P-value Age (years) 47.35 ± 15.13 50.52 ± 16.27 0.494 Gender (male/female) 0.884 Male 8 11 Female 12 18 BMI (kg/m2) 24.78 ± 2.78 23.91 ± 2.27 0.235 follow-up duration (months) 15.05 ± 1.82 15.03 ± 1.61 0.975 Hospital Stay (days) 4.40 ± 1.39 4.28 ± 0.59 0.670 Segments 0.720 L1/L2 1 2 L2/L3 0 1 L3/L4 2 1 L4/L5 5 10 L5/S1 12 15 fluoroscopy frequency (times) 8.80 ± 1.20 3.28 ± 1.03 <0.001 Duration of operation (min) 69.65 ± 7.83 78.86 ± 10.21 <0.001 HGB Reduction (g/L) 7.90 ± 2.57 11.55 ± 3.31 <0.001 Facet joint preservation rate (%) 85.16% ± 5.15% 76.06% ± 4.53% <0.001 Results are expressed as mean ±SD, number, and P < 0.05 represents statistical difference Figure 4 Comparison of fluoroscopy frequency, operative time, HGB Reduction, and Lumbar Facet preservation rate between the two groups. Clinical Outcomes Postoperative clinical symptoms of low back pain and leg pain showed significant improvement in both groups compared to preoperative levels: The mean VAS scores for low back pain and leg pain in the PELD group were 5.75 and 7.40 preoperatively, decreasing to 2.50 and 1.95 on the first postoperative day. The preoperative mean VAS scores for low back pain and leg pain in the UBE group were 5.66 and 7.31, respectively, decreasing to 2.90 and 2.10 on the first postoperative day. Both groups demonstrated continuous improvement in VAS scores for low back pain and leg pain at all postoperative time points, with no significant differences between groups (p > 0.05). Preoperative mean ODI scores for the PELD and UBE groups were 57.70 and 56.62, respectively, decreasing to 9.15 and 8.72 at 1 year postoperatively. At 1 year postoperatively, patients completed the modified MacNab questionnaire, yielding an excellent/good rate of 90.00% in the PELD group and 93.10% in the UBE group, with no statistically significant difference (Table 2, Figure 5). Table 2 Preoperative and postoperative VAS, ODI, and MacNab 12 months after surgery PELD（N = 20 ) UBE（N = 29 ) P-value LBP VAS score Preoperative 5.75 ± 1.59 5.66 ± 1.54 0.835 Post-1 day 2.50 ± 1.15 2.90 ± 1.26 0.260 Post-1 month 1.60 ± 1.05 2.00 ± 1.28 0.254 Post-6 months 1.45 ± 1.10 1.76 ± 1.35 0.403 Post-12 months 1.30 ± 1.13 1.48 ± 1.02 0.558 LP VAS score Preoperative 7.40 ± 1.10 7.31 ± 1.14 0.784 Post-1 day 1.95 ± 1.05 2.10 ± 1.01 0.613 Post-1 month 1.50 ± 1.05 1.62 ± 1.08 0.700 Post-6 months 1.30 ± 0.92 1.34 ± 0.97 0.872 Post-12 months 1.10 ± 1.17 1.21 ± 0.77 0.701 Pre ODI 57.70 ± 13.71 56.62 ± 12.62 0.757 Post-1 year ODI 9.15 ± 4.72 8.72 ± 3.93 0.733 Post-1 year MacNab 0.831 Excellent 7 14 good 11 13 fair 1 1 poor 1 1 Results are expressed as mean ±SD, number, and P < 0.05 represents statistical difference Figure 5 Comparison of LBP and LP VAS between two groups. Complications and Recurrence Two complications occurred in the PELD group: One patient experienced a minor dural tear intraoperatively, which required no special treatment; Another patient developed postoperative lower extremity paresthesia, and the symptoms improved after 5 days of postoperative observation. No severe consequences were reported in either case. At 1 year postoperatively, two patients in the PELD group developed recurrent lower extremity numbness, but the symptoms did not affect daily life, so no reoperation was performed (Table 3). Table 3 Complications and recurrence of UBE and PELD PELD（N = 20 ) UBE（N = 29 ) P-value Complications 2 (10.0) 0 (0.0) 0.559 Dural tear 1 0 Sensory impairment 1 0 Recurrence 2 0 0.082 Results are expressed as mean ±SD, number, and P < 0.05 represents statistical difference. Discussion CLDH is a distinct subtype of lumbar disc herniation [15]. Current studies have identified its associations with infection, persistent microtrauma, metabolic influences, local tissue ischemia, and a lumbar disc herniation disease course exceeding 6 months [11, 26]. Literature reports indicate that patients with CLDH experience more severe chronic back pain and lower limb radicular pain compared to those with LDH, Conservative treatment yields poor outcomes and is prone to recurrence, which is unacceptable to many patients, often necessitating surgical intervention [27]. Traditional open surgery has long been the standard approach for CLDH; however, it is associated with multiple postoperative issues. Relevant studies have further suggested that traditional open surgery may increase the risk of postoperative spinal stenosis and spondylolisthesis [28-29]. In contrast, UBE surgery is an emerging technique for degenerative lumbar diseases. Since its first report by Kambin et al. in 1996 [30], it has been applied to various complex degenerative lumbar conditions, such as severe lumbar spinal stenosis, spondylolisthesis, far-lateral disc herniation, and high-grade downward-migrated lumbar disc herniation, demonstrating excellent clinical efficacy [31–34]. The purpose of this study was to analyze and compare the clinical efficacy of PELD and UBE in the treatment of CLDH, as well as to evaluate the invasion of lumbar facet joints by these two surgical methods. Our study revealed that both groups exhibited significant improvements in VAS pain scores and ODI functional status on the first postoperative day, as well as at 1 month, 6 months, and 1 year postoperatively. Additionally, the excellent and good rates based on the modified MacNab criteria at 1 year postoperatively were 90.0% and 93.1% for the PELD and UBE groups, respectively. These findings confirm that both surgical methods are effective for CLDH. However, the PELD group had smaller incision, shorter operation time, and lower reduction of pre- and postoperative hemoglobin difference, which indicated that PELD had less damage than UBE. From the perspective of biomechanics, facet joints play a key role in the stability of the spine. The degeneration of facet joints is closely related to chronic low back pain [35]. Therefore, in lumbar decompression surgery, spine surgeons should preserve the lumbar facet joints as much as possible to prevent postoperative instability [36]. Our study found that the resection of facet joints by UBE was greater than that by PELD, and the difference was statistically significant. Previous studies have reported that the average facet joint retention rate for UBE ranges from 80.0% to 95.6% [32, 37-38]. In our study, the facet joint retention rate for UBE was 76.06%, slightly lower than the values reported in previous research. We believe this difference is necessary, however: in clinical practice, calcified discs are more difficult to remove than non-calcified discs [4], so a larger surgical working space is required to maximize the removal of calcified tissue [39] and relieve nerve root compression. During postoperative follow-up, VAS scores for low back pain in the UBE group were consistently higher than those in the PELD group—likely attributable to the greater damage to facet joints and surrounding soft tissues caused by UBE. Two complications occurred in the PELD group: one patient experienced a minor dural tear intraoperatively but no special treatment was administered, and no severe postoperative consequences were observed, and another developed postoperative lower extremity paresthesia And symptoms improved after a period of observation, and the patient was discharged. This may be due to the limitation of PELD operation channel, which makes it difficult to separate calcified intervertebral disc and nerve root; And during the operation, instruments or radiofrequency operation may lead to dural injury, adhesion of soft tissue in the spinal canal, shedding of huge disc fragments and relaxation of the dura mater, which are the risk factors for the occurrence of dural tear [40]. According to a study by Zhang [39] et al., PELD is not suitable for severe disc calcification because it will increase the chance of complications of surgery. The emergence of UBE has just solved this problem. UBE technology has independent working and observation channels, providing greater surgical flexibility and broad vision [19], and the angle of the instrument will not hinder the independent operation of the working channel [41], which makes UBE able to treat more complex calcified disc herniation; In the case, we used UBE to treat a patient with intervertebral disc calcification and ossification of the ligamentum flavum at the same time. The postoperative computed tomography scan showed that the calcified intervertebral disc and ligamentum flavum were basically removed, and the clinical symptoms of the patient were greatly improved without complications. Therefore, we suggest that PELD surgery can be used to minimize the trauma for mild calcification, but in the face of complex patients, such as simultaneous spinal stenosis, disc herniation and calcification, UBE technology is obviously a better choice. This study has certain limitations. The first is the lack of follow-up time. In the future, we will continue the follow-up to further verify our conclusion; Secondly, our study is a single center retrospective study, which has the common defects of retrospective study. Due to the different operating habits of different surgeons, there may be some differences with other hospitals in surgical technology and postoperative management, so we need to cooperate with other medical institutions for prospective research. Finally, our sample size is insufficient, which will make our results less stable and less representative; In the future, we will continue to increase the sample size and increase the reliability of our conclusions. Conclusion In conclusion, PELD and UBE are both minimally invasive surgical methods for the treatment of CLDH. However, before surgery, spine surgeons should carefully evaluate the degree of disc calcification and other factors that may affect the outcome of surgery. For single disc herniation with calcification, we recommend PELD; However, if there are disc herniation, calcification, spinal stenosis or even hypertrophy or ossification of the ligamentum flavum at the same time, we recommend using UBE. Declarations Author contributions BH , ZFC and TT made substantial contributions to the conception and design of the work; QW ,LKL and ZJC made substantial contributions to the analysis and interpretation of data; ZFC, JFH , HNL and HX drafted the work; All authors revised it critically for important intellectual content; All authors approved the version to be published; All authors agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. Funding Our study on biomedicine has no financial support. Data availability The data of this article can be obtained from the corresponding author. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8027015","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":549594039,"identity":"b999e84c-f913-485f-b147-55992a6d2683","order_by":0,"name":"Zhifeng Cheng","email":"","orcid":"","institution":"Jiangxi Province Hospital of Integrated Chinese and Western Medicine","correspondingAuthor":false,"prefix":"","firstName":"Zhifeng","middleName":"","lastName":"Cheng","suffix":""},{"id":549594040,"identity":"11caa8a1-fa06-4baa-9972-7c1bfbc9e6f0","order_by":1,"name":"Tao Tang","email":"","orcid":"","institution":"Jiangxi Province Hospital of Integrated Chinese and Western Medicine","correspondingAuthor":false,"prefix":"","firstName":"Tao","middleName":"","lastName":"Tang","suffix":""},{"id":549594041,"identity":"13b18f67-c36b-40fc-8aa0-a4bb6edf7b59","order_by":2,"name":"Qiang Wu","email":"","orcid":"","institution":"Jiangxi Province Hospital of Integrated Chinese and Western Medicine","correspondingAuthor":false,"prefix":"","firstName":"Qiang","middleName":"","lastName":"Wu","suffix":""},{"id":549594042,"identity":"b088f565-5358-4954-ac89-4fafa41b4bfb","order_by":3,"name":"Likan Liang","email":"","orcid":"","institution":"Jiangxi Province Hospital of Integrated Chinese and Western Medicine","correspondingAuthor":false,"prefix":"","firstName":"Likan","middleName":"","lastName":"Liang","suffix":""},{"id":549594043,"identity":"341f894a-e0c3-401d-8b25-da50af03c90d","order_by":4,"name":"Zhijun Chen","email":"","orcid":"","institution":"Jiangxi Province Hospital of Integrated Chinese and Western 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version.\u003c/p\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e","description":"","filename":"floatimage4.png","url":"https://assets-eu.researchsquare.com/files/rs-8027015/v1/d8c7b023b9ee547b873b1bdd.png"},{"id":97368732,"identity":"0e7e15ae-2519-4142-a02a-5ea56e654dbd","added_by":"auto","created_at":"2025-12-03 16:22:52","extension":"jpeg","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":504518,"visible":true,"origin":"","legend":"\u003cp\u003eLegend not included with this version.\u003c/p\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e","description":"","filename":"floatimage5.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-8027015/v1/65ac6d58c0e4a6f141a1e120.jpeg"},{"id":100406045,"identity":"2cb2e17a-d332-4766-9737-367ee6458223","added_by":"auto","created_at":"2026-01-16 12:36:01","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1835560,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8027015/v1/69c7f5f8-14aa-4b1f-ac53-4534c46101f9.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Comparison of clinical efficacy and facet joint invasiveness between unilateral biportal endoscopic and percutaneous endoscopic lumbar discectomy treatment of calcified lumbar disc herniation: a retrospective analysis","fulltext":[{"header":"Introduction","content":"\u003cp\u003eCalcified lumbar disc herniation (CLDH), a variant of lumbar disc herniation (LDH), is a more complex condition characterized by concurrent disc herniation and calcification [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. It has been reported in the literature that its incidence ranges from 4.7% to 15.9% [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. The main symptoms of CLDH include lower limb pain, numbness, weakness, and bladder dysfunction [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. In the process of calcification, the intervertebral disc may adhere to the peripheral nerve and dural sac, which will lead to the tear of dural sac, leakage of cerebrospinal fluid and peripheral nerve injury more easily [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. So the treatment of CLDH is different from that of LDH. When conservative treatment is ineffective for a period of time or has seriously affected the daily life of patients, surgical treatment should be sought [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Open surgery is the standard surgical procedure for the treatment of CLDH [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e], but due to the large trauma, large blood loss, slow postoperative recovery, and even muscle atrophy [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e], people are constantly looking for new technologies to replace the traditional open surgery. Percutaneous endoscopic lumbar discectomy (PELD) is a minimally invasive surgical method for the treatment of LDH, which is characterized by small incision, minimal intraoperative bleeding, short hospital stays, and even ambulatory surgery, making it more and more widely used in LDH surgery [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Recently, PELD has also been reported to treat CLDH, and the outcome is satisfactory [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. However, due to a single observation and working channel, the flexibility of PELD is greatly reduced, and CLDH mostly has adhesion to the peripheral nerve and dural sac, which is prone to complications such as nerve root injury and dural tear [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. We reviewed relevant reports showing that the incidence of complications of PELD in the treatment of CLDH is 2.0% \u0026minus;\u0026thinsp;12.9% [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan additionalcitationids=\"CR14 CR15 CR16\" citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e], which requires surgeons to have rich experience to avoid neurological complications [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Unilateral biportal endoscopic (UBE) is a new surgical method, and its separate observation and operation channels greatly make up for the shortcomings of PELD [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]; Recently, many studies have reported that UBE has achieved good results in the treatment of various types of LDH [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. Our aim is to compare the clinical efficacy and radiographic outcomes of PELD and UBE in the treatment of CLDH, so as to provide a new idea for spine surgeons in the treatment of CLDH.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cp\u003eThis study is a single center, non randomized, retrospective case-control study. The data of 49 CLDH patients who underwent PELD and UBE surgery in Jiangxi Provincial Hospital of Integrated Traditional Chinese and Western Medicine from January 2016 to August 2024 were collected and analyzed. They were divided into PELD group (20 patients) and UBE group (29 patients). The demographic, clinical outcomes and surgery related clinical data were collected.\u003c/p\u003e\n\u003cp\u003eInclusion Criteria\u003c/p\u003e\n\u003cp\u003e(1) Patients with LDH confirmed by magnetic resonance imaging (MRI) and CLDH verified by computed tomography (CT);(2) Patients with lower limb pain and numbness who showed no response to standard conservative treatment for 6 months;(3) Patients with single-segment CLDH symptoms who agreed to undergo PELD or UBE;(4) Patients with complete clinical data;(5) Patients who completed follow-up for more than 12 months.\u003c/p\u003e\n\u003cp\u003eExclusion Criteria\u003c/p\u003e\n\u003cp\u003e(1) Patients with other types of LDH without calcification or with calcification involving multiple segments;(2) Patients with lumbar spondylolisthesis, scoliosis, lumbar tumors, lumbar infections, or ankylosing spondylitis;(3) Patients with single-segment or multi-segment lumbar instability (defined as \u0026gt; 3 mm translational displacement or \u0026gt; 5\u0026deg; angular change); (4) Patients with severe underlying diseases who could not tolerate anesthesia; (5) Patients with a follow-up duration of less than 1 year.\u003c/p\u003e\n\u003cp\u003eEthical Approval\u003c/p\u003e\n\u003cp\u003eThis study was approved by the Ethics Committee of Jiangxi Provincial Hospital of Integrated Traditional Chinese and Western Medicine and complied with the ethical standards outlined in the \u003cem\u003eDeclaration of Helsinki\u003c/em\u003e. All patients who underwent surgery signed an informed consent form for clinical research.\u003c/p\u003e\n\u003cp\u003eDemographic, clinical outcome, and surgical information collection\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eCollect demographic characteristics including age (years), gender (male/female), body mass index (BMI, kg/m\u0026sup2;), and follow-up duration (months). Record surgery-related parameters including: length of hospital stay (days), surgical segment, fluoroscopy frequency (times), operative time (minutes), pre- and post-operative hemoglobin difference (g/L), and lumbar facet preservation rate (%).Clinical outcomes included visual analog scale (VAS) scores [22] for low back pain and leg pain at preoperative, day 1 postoperatively, 1 month postoperatively, 6 months postoperatively, and 12 months postoperatively; Oswestry Disability Index (ODI) [23] scores at preoperative and 12 months postoperatively; modified MacNab scores [24] at the final follow-up; surgical complications; and recurrence at 1 year postoperatively. Lumbar CT scans were rechecked on the 3rd postoperative day. The facet joint retention rate at the surgical segment was calculated using axial CT views. Taking the L5/S1 segment as an example, the calculation method referred to [25]:\u0026nbsp;Preoperative axial length of the middle facet joint (A) and postoperative axial length of the same facet joint (B), with the facet joint preservation rate calculated as B/A (Figure 1). The modified MacNab criteria are as follows: Excellent (100% resolution of clinical symptoms at 1 year postoperatively); Good (50\u0026ndash;99% resolution of clinical symptoms at 1 year postoperatively); Fair (1\u0026ndash;49% resolution of clinical symptoms at 1 year postoperatively); Poor (0% resolution or worsening of clinical symptoms at 1 year postoperatively).\u003c/p\u003e\n\u003cp\u003eFigure 1\u003c/p\u003e\n\u003cp\u003eA:Preoperative axial length of the middle facet joint; B:postoperative axial length of the same facet joint; facet joint preservation rate calculated as B/A.\u003c/p\u003e\n\u003cp\u003eSurgery\u003c/p\u003e\n\u003cp\u003eUBE\u003c/p\u003e\n\u003cp\u003eThe all procedures were performed by an experienced spine surgeon, B.H. The patient was positioned prone. Following successful induction of general anesthesia, the target intervertebral space and working channel were identified under C-arm fluoroscopy. The working channel was located approximately 1 cm lateral to the junction of the spinous process and lamina. and the viewing channel was established 3 cm above or below the working channel. Two skin incisions (each 0.8\u0026ndash;1.5 cm in length) were made at the sites of the working and viewing channels. Soft tissues were gradually dilated using dilators, followed by insertion of surgical instruments and the endoscope. Radiofrequency ablation was used to coagulate soft tissues and create a working space. A high-speed burr, osteotome, and rongeur were employed to remove parts of the lamina and superior/inferior articular processes, ensuring adequate exposure of the cephalad and caudal ligamentum flavum. A portion of the ligamentum flavum was resected to expose and mobilize the traversing and exiting roots of the target nerve. The herniated calcified nucleus pulposus was then removed, and the annulus fibrosus was sutured to prevent postoperative recurrence. Intraoperative dural sac injury was managed as follows: minor injuries did not require special treatment, but a second operation was performed if persistent cerebrospinal fluid leakage occurred postoperatively; for major injuries, an open surgical repair of the dura was performed directly. Finally, the incisions were sutured to complete the surgery (Figure 2).\u003c/p\u003e\n\u003cp\u003eFigure 2\u003c/p\u003e\n\u003cp\u003eAn 89 year old male patient had low back pain with leg pain in both lower limbs for more than 20 years, and had radiating pain, numbness and fatigue in both lower limbs in recent 20 days; The straight leg raising test of both lower limbs was positive, and the muscle strength of both lower limbs was grade 4. Lumbar magnetic resonance showed lumbar 4-5 intervertebral disc herniation, ligamentum flavum hypertrophy, and spinal canal stenosis (white circles in Figure A and B); CT of the lumbar spine showed herniation and calcification of the intervertebral disc and ossification of the ligamentum flavum of the lumbar spine (black circles in Figure C and D). We performed UBE for him. The postoperative patients felt that the low back pain was significantly improved compared with that before operation, and the radiating pain, numbness and fatigue of both lower limbs were significantly improved compared with that before operation; Postoperative reexamination of lumbar CT showed that the herniated and calcified intervertebral discs were basically removed, and the ossified ligamentum flavum was basically removed (Fig. F and G). We performed pathological examination of the nucleus pulposus, suggesting the presence of dead bone tissue in the nucleus pulposus.\u003c/p\u003e\n\u003cp\u003ePELD\u003c/p\u003e\n\u003cp\u003eAll PELD procedures were conducted by the same experienced spine surgeon (Surgeon T.T.). Thirty minutes before surgery, patients received 8 mg lornoxicam for injection (a non-steroidal anti-inflammatory drug) for pain relief. The transforaminal approach was adopted: patients were placed in the lateral decubitus position, and the surgical site was confirmed under C-arm fluoroscopy. The surgeon administered local infiltration anesthesia using an 18G needle with an appropriate volume of 1% lidocaine, and patients remained awake throughout the entire procedure. A single skin incision (0.8\u0026ndash;1.5 cm in length) was made, and soft tissues were gradually dilated with dilators before inserting the endoscope and surgical instruments. If the intervertebral foramen was found to be too narrow during the operation, a rongeur was used to resect part of the bone to ensure the smooth progression of the surgery.Subsequently, nerve root decompression was performed, and the herniated calcified intervertebral disc was carefully removed. Intraoperative dural sac injury was managed using the same protocol as in UBE surgery. After completion of decompression, the incision was sutured to finish the surgery\u0026nbsp;(Figure 3).\u003c/p\u003e\n\u003cp\u003eFigure 3\u003c/p\u003e\n\u003cp\u003eA 29 year old male patient had low back pain with radiating pain of the right lower limb for 1 year, which aggravated for 10 days. The right straight leg elevation test was positive, and the muscle strength of both lower limbs was normal. MRI revealed that the L5-S1 intervertebral disc protruded to the right side and compressed the nerve root; CT of lumbar spine showed calcification of intervertebral disc; We performed PELD for him, and the symptoms of the patient\u0026apos;s right lower limb disappeared and the low back pain was significantly relieved after the operation.\u003c/p\u003e\n\u003cp\u003ePerioperative Management\u003c/p\u003e\n\u003cp\u003ePostoperatively, patients received general symptomatic treatment including analgesia. They were instructed to perform in-bed muscle contraction exercises to prevent complications (e.g., lower extremity deep vein thrombosis). Based on individual patient conditions, early ambulation was encouraged with the use of a customized lumbar brace, typically starting on the 2nd postoperative day. On the 3rd postoperative day, patients underwent lumbar X-ray, computed tomography scan, and lumbar MRI examinations. If the postoperative reexamination results were satisfactory, patients were generally permitted to be discharged on the 4th postoperative day.\u003c/p\u003e\n\u003cp\u003eStatistical Analysis\u003c/p\u003e\n\u003cp\u003eData were processed using SPSS 26.0 statistical software. We first conducted normality tests on continuous data. For data meeting normal distribution criteria, analysis was performed using the independent samples t-test, with results expressed as mean \u0026plusmn; standard deviation. For data not meeting normal distribution criteria, For categorical data, the Kruskal-Wallis test was applied; categorical data were analyzed using the chi-square test or Fisher\u0026apos;s exact test. A p-value \u0026lt; 0.05 was considered statistically significant.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eDemographic and Surgical Outcomes\u003c/p\u003e\n\u003cp\u003eThroughout the process, 55 patients with calcified disc herniation underwent PELD or UBE surgery. Among them, 3 patients were lost to follow-up, and 3 patients lacked complete imaging data. Ultimately, 49 patients were included in this study: 20 patients underwent PELD surgery, and 29 patients underwent UBE surgery. There were no significant differences between the two groups in age, gender, BMI, or follow-up duration (p \u0026gt; 0.05) (Table 1). Hospital Stay and surgical segment showed no significant differences between groups (p \u0026gt; 0.05). Significant differences were observed in\u0026nbsp;fluoroscopy frequency, operative time, pre- and postoperative hemoglobin difference, and lumbar facet preservation rate (p \u0026lt; 0.05). PELD required an average of 5.52 more fluoroscopy frequency than UBE. PELD operative time was 9.21 minutes shorter than UBE. The mean pre- and postoperative hemoglobin difference was 3.65 g/L lower in PELD than in UBE. The lumbar facet preservation rate was 9.10% higher in PELD than in UBE (Table 1, Figure 4).\u003c/p\u003e\n\u003cp\u003eTable 1 Comparison of basic demographic information and surgical indicators of patients\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003ePELD（N = 20 )\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003eUBE（N = 29 )\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003eP-value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003eAge (years)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e47.35 \u0026plusmn; 15.13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e50.52 \u0026plusmn; 16.27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e0.494\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003eGender (male/female)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e0.884\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003eBMI (kg/m2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e24.78 \u0026plusmn; 2.78\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e23.91 \u0026plusmn; 2.27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e0.235\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003efollow-up duration (months)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e15.05 \u0026plusmn; 1.82\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e15.03 \u0026plusmn; 1.61\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e0.975\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003eHospital Stay (days)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e4.40 \u0026plusmn; 1.39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e4.28 \u0026plusmn; 0.59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e0.670\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003eSegments\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e0.720\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003eL1/L2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003eL2/L3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003eL3/L4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003eL4/L5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003eL5/S1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003efluoroscopy frequency (times)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e8.80 \u0026plusmn; 1.20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e3.28 \u0026plusmn; 1.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003eDuration of operation (min)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e69.65 \u0026plusmn; 7.83\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e78.86 \u0026plusmn; 10.21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003eHGB Reduction (g/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e7.90 \u0026plusmn; 2.57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e11.55 \u0026plusmn; 3.31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003eFacet joint preservation rate (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e85.16% \u0026plusmn; 5.15%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e76.06% \u0026plusmn; 4.53%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eResults are expressed as mean\u0026nbsp;\u0026plusmn;SD, number, and P \u0026lt; 0.05 represents statistical difference\u003c/p\u003e\n\u003cp\u003eFigure 4\u003c/p\u003e\n\u003cp\u003eComparison of fluoroscopy frequency, operative time, HGB Reduction, and Lumbar Facet preservation rate between the two groups.\u003c/p\u003e\n\u003cp\u003eClinical Outcomes\u003c/p\u003e\n\u003cp\u003ePostoperative clinical symptoms of low back pain and leg pain showed significant improvement in both groups compared to preoperative levels: The mean VAS scores for low back pain and leg pain in the PELD group were 5.75 and 7.40 preoperatively, decreasing to 2.50 and 1.95 on the first postoperative day. The preoperative mean VAS scores for low back pain and leg pain in the UBE group were 5.66 and 7.31, respectively, decreasing to 2.90 and 2.10 on the first postoperative day. Both groups demonstrated continuous improvement in VAS scores for low back pain and leg pain at all postoperative time points, with no significant differences between groups (p \u0026gt; 0.05). Preoperative mean ODI scores for the PELD and UBE groups were 57.70 and 56.62, respectively, decreasing to 9.15 and 8.72 at 1 year postoperatively. At 1 year postoperatively, patients completed the modified MacNab questionnaire, yielding an excellent/good rate of 90.00% in the PELD group and 93.10% in the UBE group, with no statistically significant difference\u0026nbsp;(Table 2, Figure 5).\u003c/p\u003e\n\u003cp\u003eTable 2 Preoperative and postoperative VAS, ODI, and MacNab 12 months after surgery\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003ePELD（N = 20 )\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003eUBE（N = 29 )\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003eP-value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003eLBP VAS score\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003ePreoperative\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e5.75\u0026nbsp;\u0026plusmn;\u0026nbsp;1.59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e5.66\u0026nbsp;\u0026plusmn;\u0026nbsp;1.54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e0.835\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003ePost-1 day\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e2.50\u0026nbsp;\u0026plusmn;\u0026nbsp;1.15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e2.90\u0026nbsp;\u0026plusmn;\u0026nbsp;1.26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e0.260\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003ePost-1 month\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e1.60\u0026nbsp;\u0026plusmn;\u0026nbsp;1.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e2.00\u0026nbsp;\u0026plusmn;\u0026nbsp;1.28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e0.254\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003ePost-6 months\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e1.45\u0026nbsp;\u0026plusmn;\u0026nbsp;1.10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e1.76\u0026nbsp;\u0026plusmn;\u0026nbsp;1.35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e0.403\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003ePost-12 months\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e1.30\u0026nbsp;\u0026plusmn;\u0026nbsp;1.13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e1.48 \u0026nbsp;\u0026plusmn; 1.02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e0.558\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003eLP VAS score\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003ePreoperative\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e7.40\u0026nbsp;\u0026plusmn;\u0026nbsp;1.10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e7.31\u0026nbsp;\u0026plusmn;\u0026nbsp;1.14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e0.784\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003ePost-1 day\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e1.95\u0026nbsp;\u0026plusmn;\u0026nbsp;1.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e2.10\u0026nbsp;\u0026plusmn;\u0026nbsp;1.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e0.613\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003ePost-1 month\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e1.50\u0026nbsp;\u0026plusmn;\u0026nbsp;1.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e1.62\u0026nbsp;\u0026plusmn;\u0026nbsp;1.08\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e0.700\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003ePost-6 months\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e1.30\u0026nbsp;\u0026plusmn;\u0026nbsp;0.92\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e1.34\u0026nbsp;\u0026plusmn;\u0026nbsp;0.97\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e0.872\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003ePost-12 months\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e1.10\u0026nbsp;\u0026plusmn;\u0026nbsp;1.17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e1.21\u0026nbsp;\u0026plusmn;\u0026nbsp;0.77\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e0.701\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003ePre ODI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e57.70\u0026nbsp;\u0026plusmn;\u0026nbsp;13.71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e56.62\u0026nbsp;\u0026plusmn;\u0026nbsp;12.62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e0.757\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003ePost-1 year ODI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e9.15\u0026nbsp;\u0026plusmn;\u0026nbsp;4.72\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e8.72\u0026nbsp;\u0026plusmn;\u0026nbsp;3.93\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e0.733\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003ePost-1 year MacNab\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e0.831\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003eExcellent\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003egood\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003efair\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003epoor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eResults are expressed as mean\u0026nbsp;\u0026plusmn;SD, number, and P \u0026lt; 0.05 represents statistical difference\u003c/p\u003e\n\u003cp\u003eFigure 5\u003c/p\u003e\n\u003cp\u003eComparison of LBP and LP VAS between two groups.\u003c/p\u003e\n\u003cp\u003eComplications and Recurrence\u003c/p\u003e\n\u003cp\u003eTwo complications occurred in the PELD group: One patient experienced a minor dural tear intraoperatively, which required no special treatment; Another patient developed postoperative lower extremity paresthesia, and the symptoms improved after 5 days of postoperative observation. No severe consequences were reported in either case. At 1 year postoperatively, two patients in the PELD group developed recurrent lower extremity numbness, but the symptoms did not affect daily life, so no reoperation was performed\u0026nbsp;(Table 3).\u003c/p\u003e\n\u003cp\u003eTable 3 Complications and recurrence of UBE and PELD\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003ePELD（N = 20 )\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003eUBE（N = 29 )\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003eP-value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003eComplications\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e2 (10.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e0.559\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003eDural tear\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003eSensory impairment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003eRecurrence\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e0.082\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eResults are expressed as mean \u0026plusmn;SD, number, and P \u0026lt; 0.05 represents statistical difference.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eCLDH is a distinct subtype of lumbar disc herniation [15]. Current studies have identified its associations with infection, persistent microtrauma, metabolic influences, local tissue ischemia, and a lumbar disc herniation disease course exceeding 6 months [11, 26].\u0026nbsp;Literature reports indicate that patients with CLDH experience more severe chronic back pain and lower limb radicular pain compared to those with LDH, Conservative treatment yields poor outcomes and is prone to recurrence, which is unacceptable to many patients, often necessitating surgical intervention [27]. Traditional open surgery has long been the standard approach for CLDH; however, it is associated with multiple postoperative issues. Relevant studies have further suggested that traditional open surgery may increase the risk of postoperative spinal stenosis and spondylolisthesis [28-29]. In contrast, UBE surgery is an emerging technique for degenerative lumbar diseases. Since its first report by Kambin et al. in 1996 [30], it has been applied to various complex degenerative lumbar conditions, such as severe lumbar spinal stenosis, spondylolisthesis, far-lateral disc herniation, and high-grade downward-migrated lumbar disc herniation, demonstrating excellent clinical efficacy [31\u0026ndash;34]. The purpose of this study was to analyze and compare the clinical efficacy of PELD and UBE in the treatment of CLDH, as well as to evaluate the invasion of lumbar facet joints by these two surgical methods.\u003c/p\u003e\n\u003cp\u003eOur study revealed that both groups exhibited significant improvements in VAS pain scores and ODI functional status on the first postoperative day, as well as at 1 month, 6 months, and 1 year postoperatively. Additionally, the excellent and good rates based on the modified MacNab criteria at 1 year postoperatively were 90.0% and 93.1% for the PELD and UBE groups, respectively. These findings confirm that both surgical methods are effective for CLDH.\u0026nbsp;However, the PELD group had smaller incision, shorter operation time, and lower reduction of pre- and postoperative hemoglobin difference, which indicated that PELD had less damage than UBE.\u003c/p\u003e\n\u003cp\u003eFrom the perspective of biomechanics, facet joints play a key role in the stability of the spine. The degeneration of facet joints is closely related to chronic low back pain [35]. Therefore, in lumbar decompression surgery, spine surgeons should preserve the lumbar facet joints as much as possible to prevent postoperative instability [36]. Our study found that the resection of facet joints by UBE was greater than that by PELD, and the difference was statistically significant. Previous studies have reported that the average facet joint retention rate for UBE ranges from 80.0% to 95.6% [32, 37-38]. In our study, the facet joint retention rate for UBE was 76.06%, slightly lower than the values reported in previous research. We believe this difference is necessary, however: in clinical practice, calcified discs are more difficult to remove than non-calcified discs [4], so a larger surgical working space is required to maximize the removal of calcified tissue [39] and relieve nerve root compression. During postoperative follow-up, VAS scores for low back pain in the UBE group were consistently higher than those in the PELD group\u0026mdash;likely attributable to the greater damage to facet joints and surrounding soft tissues caused by UBE.\u003c/p\u003e\n\u003cp\u003eTwo complications occurred in the PELD group: one patient experienced a minor dural tear intraoperatively but no special treatment was administered, and no severe postoperative consequences were observed, and another developed postoperative lower extremity paresthesia And symptoms improved after a period of observation, and the patient was discharged.\u0026nbsp;This may be due to the limitation of PELD operation channel, which makes it difficult to separate calcified intervertebral disc and nerve root; And during the operation, instruments or radiofrequency operation may lead to dural injury, adhesion of soft tissue in the spinal canal, shedding of huge disc fragments and relaxation of the dura mater, which are the risk factors for the occurrence of dural tear [40].\u0026nbsp;According to a study by Zhang [39] et al., PELD is not suitable for severe disc calcification because it will increase the chance of complications of surgery.\u0026nbsp;The emergence of UBE has just solved this problem. UBE technology has independent working and observation channels, providing greater surgical flexibility and broad vision [19], and the angle of the instrument will not hinder the independent operation of the working channel [41], which makes UBE able to treat more complex calcified disc herniation;\u0026nbsp;In the case, we used UBE to treat a patient with intervertebral disc calcification and ossification of the ligamentum flavum at the same time. The postoperative computed tomography scan showed that the calcified intervertebral disc and ligamentum flavum were basically removed, and the clinical symptoms of the patient were greatly improved without complications. Therefore, we suggest that PELD surgery can be used to minimize the trauma for mild calcification, but in the face of complex patients, such as simultaneous spinal stenosis, disc herniation and calcification, UBE technology is obviously a better choice.\u003c/p\u003e\n\u003cp\u003eThis study has certain limitations. The first is the lack of follow-up time. In the future, we will continue the follow-up to further verify our conclusion; Secondly, our study is a single center retrospective study, which has the common defects of retrospective study. Due to the different operating habits of different surgeons, there may be some differences with other hospitals in surgical technology and postoperative management, so we need to cooperate with other medical institutions for prospective research. Finally, our sample size is insufficient, which will make our results less stable and less representative; In the future, we will continue to increase the sample size and increase the reliability of our conclusions.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eIn conclusion, PELD and UBE are both minimally invasive surgical methods for the treatment of CLDH. However, before surgery, spine surgeons should carefully evaluate the degree of disc calcification and other factors that may affect the outcome of surgery. For single disc herniation with calcification, we recommend PELD; However, if there are disc herniation, calcification, spinal stenosis or even hypertrophy or ossification of the ligamentum flavum at the same time, we recommend using UBE.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eAuthor contributions\u003c/p\u003e\n\u003cp\u003eBH , ZFC and TT made substantial contributions to the conception and design of the work; QW ,LKL and ZJC made substantial contributions to the analysis and interpretation of data; ZFC, JFH , HNL and HX drafted the work; All authors revised it critically for important intellectual content; All authors approved the version to be published; All authors agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.\u003c/p\u003e\n\u003cp\u003eFunding\u003c/p\u003e\n\u003cp\u003eOur study on biomedicine has no financial support.\u003c/p\u003e\n\u003cp\u003eData availability\u003c/p\u003e\n\u003cp\u003eThe data of this article can be obtained from the corresponding author.\u003c/p\u003e\n\u003cp\u003eDeclarations\u003c/p\u003e\n\u003cp\u003eEthics and Consent to participate\u003c/p\u003e\n\u003cp\u003eThis study has been approved by the ethics committee of Jiangxi Province Hospital of Integrated Chinese and Western Medicine. All participating patients signed informed consent before surgery.\u003c/p\u003e\n\u003cp\u003eConsent for publication\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003eCompeting interests\u003c/p\u003e\n\u003cp\u003eNo conflict of interest involved.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eKUMAR V, BANSAL P, DHILLON M, et al. Surgical techniques and perioperative surgical outcomes after discectomy for calcified lumbar disc herniation: a review and meta-analysis [J]. Eur Spine J, 2024, 33(1): 47-60.\u003c/li\u003e\n\u003cli\u003eKARAMOUZIAN S, ESKANDARY H, FARAMARZEE M, et al. Frequency of lumbar intervertebral disc calcification and angiogenesis, and their correlation with clinical, surgical, and magnetic resonance imaging findings [J]. Spine (Phila Pa 1976), 2010, 35(8): 881-6.\u003c/li\u003e\n\u003cli\u003eCHENG X G, BRYS P, NIJS J, et al. Radiological prevalence of lumbar intervertebral disc calcification in the elderly: an autopsy study [J]. Skeletal Radiol, 1996, 25(3): 231-5.\u003c/li\u003e\n\u003cli\u003eCHENG Y, ZHANG Q, LI Y, et al. Percutaneous endoscopic interlaminar discectomy for L5-S1 calcified lumbar disc herniation: A retrospective study [J]. Front Surg, 2022, 9: 998231.\u003c/li\u003e\n\u003cli\u003eBOSTELMANN R, EICKER S, STEIGER H J, et al. Spontaneous disruption of dura mater and fascicular continuity of the L5 nerve root by a calcified disc herniation [J]. Acta Neurochir (Wien), 2011, 153(7): 1447-8.\u003c/li\u003e\n\u003cli\u003eHAHNE A J, FORD J J, MCMEEKEN J M. Conservative management of lumbar disc herniation with associated radiculopathy: a systematic review [J]. Spine (Phila Pa 1976), 2010, 35(11): E488-504.\u003c/li\u003e\n\u003cli\u003eLIU N, CHEN Z, QI Q, et al. 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Percutaneous Endoscopic Lumbar Discectomy in Treating Calcified Lumbar Intervertebral Disc Herniation [J]. World Neurosurg, 2019, 122: e1449-e56.\u003c/li\u003e\n\u003cli\u003eNELLENSTEIJN J, OSTELO R, BARTELS R, et al. Transforaminal endoscopic surgery for symptomatic lumbar disc herniations: a systematic review of the literature [J]. Eur Spine J, 2010, 19(2): 181-204.\u003c/li\u003e\n\u003cli\u003eYUAN A L, SHEN X, CHEN B. Treatment of Calcified Lumbar Disc Herniation by Intervertebral Foramen Remolding: A Retrospective Study [J]. J Pain Res, 2022, 15: 1719-28.\u003c/li\u003e\n\u003cli\u003eDABO X, ZIQIANG C, YINCHUAN Z, et al. The Clinical Results of Percutaneous Endoscopic Interlaminar Discectomy (PEID) in the Treatment of Calcified Lumbar Disc Herniation: A Case-Control Study [J]. Pain Physician, 2016, 19(2): 69-76.\u003c/li\u003e\n\u003cli\u003eKIM H S, ADSUL N, JU Y S, et al. Full Endoscopic Lumbar Discectomy using the Calcification Floating Technique for Symptomatic Partially Calcified Lumbar Herniated Nucleus Pulposus [J]. World Neurosurg, 2018, 119: 500-5.\u003c/li\u003e\n\u003cli\u003eSHIN S H, BAE J S, LEE S H, et al. Transforaminal Endoscopic Discectomy for Hard or Calcified Lumbar Disc Herniation: A New Surgical Technique and Clinical Outcomes [J]. World Neurosurg, 2020, 143: e224-e31.\u003c/li\u003e\n\u003cli\u003eCHENG Y P, CHENG X K, WU H. A comparative study of percutaneous endoscopic interlaminar discectomy and transforaminal discectomy for L5-S1 calcified lumbar disc herniation [J]. BMC Musculoskelet Disord, 2022, 23(1): 244.\u003c/li\u003e\n\u003cli\u003eLEE D Y, SHIM C S, AHN Y, et al. Comparison of percutaneous endoscopic lumbar discectomy and open lumbar microdiscectomy for recurrent disc herniation [J]. J Korean Neurosurg Soc, 2009, 46(6): 515-21.\u003c/li\u003e\n\u003cli\u003eJIANG H W, CHEN C D, ZHAN B S, et al. Unilateral biportal endoscopic discectomy versus percutaneous endoscopic lumbar discectomy in the treatment of lumbar disc herniation: a retrospective study [J]. J Orthop Surg Res, 2022, 17(1): 30.\u003c/li\u003e\n\u003cli\u003eLEE C K, KIM I. Commentary on \u0026quot;Unilateral Biportal Endoscopy for Decompression of Extraforaminal Stenosis at the Lumbosacral Junction: Surgical Techniques and Clinical Outcomes\u0026quot; [J]. Neurospine, 2021, 18(4): 880-1.\u003c/li\u003e\n\u003cli\u003eTAN B, YANG Q Y, FAN B, et al. Decompression via unilateral biportal endoscopy for severe degenerative lumbar spinal stenosis: A comparative study with decompression via open discectomy [J]. Front Neurol, 2023, 14: 1132698.\u003c/li\u003e\n\u003cli\u003eMANCHIKANTI L, KAYE A D, SOIN A, et al. Comprehensive Evidence-Based Guidelines for Facet Joint Interventions in the Management of Chronic Spinal Pain: American Society of Interventional Pain Physicians (ASIPP) Guidelines Facet Joint Interventions 2020 Guidelines [J]. Pain Physician, 2020, 23(3s): S1-s127.\u003c/li\u003e\n\u003cli\u003eZHANG S P, TONG M, MO J, et al. Clinical advantages of percutaneous endoscopic lumbar discectomy combined with lumbar hyperextension pressurization in the treatment of L4/5 single-segment lumbar disc herniation [J]. J Orthop Surg Res, 2025, 20(1): 893.\u003c/li\u003e\n\u003cli\u003eZHOU S, JIANCUO A, XU X, et al. Evaluation of Hidden Blood Loss and Clinical Outcomes of Arthroscopy-Assisted Uni-Portal Spinal Surgery for Lumbar Disc Herniation with Lateral Recess Stenosis [J]. World Neurosurg, 2025, 198: 124026.\u003c/li\u003e\n\u003cli\u003eNAKAMURA S, TAGUCHI M. Area of Ostectomy in Posterior Percutaneous Endoscopic Cervical Foraminotomy: Images and Mid-term Outcomes [J]. Asian Spine J, 2017, 11(6): 968-74.\u003c/li\u003e\n\u003cli\u003eKRISHNAN A, MURUGAN C, PANTHACKEL M, et al. Transforaminal Endoscopic Ventral Stenosis Decompression in Calcified Lumbar Disc Herniation: A Long Term Outcome in 79 Patients [J]. World Neurosurg, 2024, 186: e191-e205.\u003c/li\u003e\n\u003cli\u003eWANG D, XING J, SHAO B, et al. A surgical decompression procedure for effective treatment of calcified lumbar disc herniation [J]. J Int Med Res, 2020, 48(7): 300060520938966.\u003c/li\u003e\n\u003cli\u003eLEE C K. Lumbar spinal instability (olisthesis) after extensive posterior spinal decompression [J]. Spine (Phila Pa 1976), 1983, 8(4): 429-33.\u003c/li\u003e\n\u003cli\u003eHOPP E, TSOU P M. Postdecompression lumbar instability [J]. Clin Orthop Relat Res, 1988, 227: 143-51.\u003c/li\u003e\n\u003cli\u003eDE ANTONI D J, CLARO M L, POEHLING G G, et al. Translaminar lumbar epidural endoscopy: anatomy, technique, and indications [J]. Arthroscopy, 1996, 12(3): 330-4.\u003c/li\u003e\n\u003cli\u003eDAI M, LIU Q, CHEN C, et al. Enhanced recovery after unilateral biportal endoscopic lumbar interbody fusion combined with unilateral biportal endoscopy for the treatment of severe lumbar spinal stenosis [J]. Asian J Surg, 2024, 47(5): 2435-7.\u003c/li\u003e\n\u003cli\u003eLEE D H, LEE D G, PARK C K, et al. Saving Stabilizing Structure Treatment With Bilateral-Contralateral Decompression for Spinal Stenosis in Degenerative Spondylolisthesis Using Unilateral Biportal Endoscopy [J]. Neurospine, 2023, 20(3): 931-9.\u003c/li\u003e\n\u003cli\u003eLI L, AN J, GUO L, et al. Comparison of percutaneous endoscopic lumbar discectomy (PELD) and unilateral biportal endoscopic (UBE) discectomy in the treatment of far lateral lumbar disc herniation (FLLDH): a retrospective study [J]. J Orthop Surg Res, 2025, 20(1): 510.\u003c/li\u003e\n\u003cli\u003eWANG D, YANG J, LIU C, et al. Comparative analysis of endoscopic discectomy for demanding lumbar disc herniation [J]. Sci Rep, 2025, 15(1): 9098.\u003c/li\u003e\n\u003cli\u003eMUSSO S, BUSCEMI F, BONOSSI L, et al. Lumbar facet joint stabilization for symptomatic spinal degenerative disease: A systematic review of the literature [J]. J Craniovertebr Junction Spine, 2022, 13(4): 401-9.\u003c/li\u003e\n\u003cli\u003eGETTY C J, JOHNSON J R, KIRWAN E O, et al. Partial undercutting facetectomy for bony entrapment of the lumbar nerve root [J]. J Bone Joint Surg Br, 1981, 63-b(3): 330-5.\u003c/li\u003e\n\u003cli\u003ePAO J L. Preliminary Clinical and Radiological Outcomes of the \u0026quot;No-Punch\u0026quot; Decompression Techniques for Unilateral Biportal Endoscopic Spine Surgery [J]. Neurospine, 2024, 21(2): 732-41.\u003c/li\u003e\n\u003cli\u003eFENG F, LI G, MENG H, et al. Clinical efficacy of unilateral biportal endoscopic technique for adjacent segment pathology following lumbar fusion [J]. J Orthop Surg Res, 2025, 20(1): 628.\u003c/li\u003e\n\u003cli\u003eZHANG K, TANG Y, LI H, et al. Sagittal Classification of Calcified Lumbar Disc Herniation and Therapeutic Analysis of Percutaneous Endoscopic Interlaminar Discectomy [J]. Orthop Surg, 2025, 17(10): 2887-94.\u003c/li\u003e\n\u003cli\u003eJU C I, LEE S M. Complications and Management of Endoscopic Spinal Surgery [J]. Neurospine, 2023, 20(1): 56-77.\u003c/li\u003e\n\u003cli\u003eZHIQIANG Z, JIANDONG Y, ZHI H, et al. Clinical Efficacy of Biportal versus Uniportal Endoscopic Discectomy for Far Lateral Lumbar Disc Herniation: A Retrospective Study Analysis [J]. World Neurosurg, 2025, 197: 123788.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Calcified lumbar disc herniation, Unilateral biportal endoscopy, percutaneous endoscopic lumbar discectomy, facet joint, clinical efficacy, invasion","lastPublishedDoi":"10.21203/rs.3.rs-8027015/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8027015/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eComparing the clinical efficacy and lumbar facet invasiveness of percutaneous endoscopic lumbar discectomy (PELD) and unilateral biportal endoscopic (UBE) treatment for calcified lumbar disc herniation (CLDH), providing new ideas for spinal surgeons to treat CLDH.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eA retrospective analysis was conducted on the data of 49 CLDH patients who underwent intervertebral disc resection surgery in our hospital from January 2016 to August 2024, including 20 who underwent PELD surgery and 29 who underwent UBE surgery. The demographic, clinical, and surgical outcomes of the two groups of patients were collected and analyzed.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eAll surgeries were completed successfully, with significant improvement in clinical symptoms observed in both groups postoperatively. The PELD group required an average of 5.52 more fluoroscopy frequency than the UBE group. The average operative time in the PELD group was 9.21 minutes shorter than in the UBE group. The mean pre-to-postoperative hemoglobin difference was 3.65 g/L lower in the PELD group than in the UBE group. The mean preservation rate of Lumbar Facet was 9.10% higher in the PELD group than in the UBE group. These differences were statistically significant (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). The excellent-to-good rate was 90.00% in the PELD group and 93.10% in the UBE group. Additionally, two patients in the PELD group experienced complications, and two patients had recurrence at 12 months postoperatively; however, none resulted in severe consequences. No complications or postoperative recurrences were observed in the UBE group.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e\u003cp\u003eBoth PELD and UBE are effective methods for the treatment of CLDH, but the surgical approach should be selected based on the actual conditions of patients. For patients with complex disc calcification, UBE is recommended.\u003c/p\u003e","manuscriptTitle":"Comparison of clinical efficacy and facet joint invasiveness between unilateral biportal endoscopic and percutaneous endoscopic lumbar discectomy treatment of calcified lumbar disc herniation: a retrospective analysis","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-12-02 17:56:47","doi":"10.21203/rs.3.rs-8027015/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"e9d3744c-77ee-46c6-86b1-7c59cd479ad1","owner":[],"postedDate":"December 2nd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-01-21T22:53:25+00:00","versionOfRecord":[],"versionCreatedAt":"2025-12-02 17:56:47","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8027015","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8027015","identity":"rs-8027015","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}