Delta large-channel endoscopic discectomy versus Unilateral biportal endoscopic discectomy in the treatment of lumbar disc herniation: A Retrospective Study

Delta large-channel endoscopic discectomy versus Unilateral biportal endoscopic discectomy in the treatment of lumbar disc herniation: A Retrospective Study | 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 Delta large-channel endoscopic discectomy versus Unilateral biportal endoscopic discectomy in the treatment of lumbar disc herniation: A Retrospective Study Guodong Guo, Yang Qiu, Suohua Pan, Daokuan Gao, Huijuan Ma, Gang Liu This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6512924/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 6 You are reading this latest preprint version Abstract OBJECTIVE To compare the clinical efficacy and safety of two posterior minimally invasive surgeries using percutaneous interlaminar approach: Delta large-channel endoscopic discectomy(DLED) versus Unilateral biportal endoscopic discectomy(UBED) in the treatment of lumbar disc herniation(LDH). METHODS A retrospective analysis was conducted on 74 LDH patients treated with DLED(39 cases) and UBED(35 cases) from January 2023 to January 2024. Observe the operation time, number of fluoroscopy, intraoperative blood loss(IBL), total blood loss(TBL), hidden blood loss(HBL), and postoperative hemoglobin(HB), hematocrit(HCT), and creatine kinase (CK)levels. At the same time, the clinical efficacy was evaluated using the pain visual analog scale(VAS), Oswestry Disability Index(ODI) and modified Macnab assessment criteria. Result Compared with DLED group, UBED group was associated with longer operation time, more Hb loss, more Hct loss, and higher CK level ( P < 0.05) . Additionally, IBL, TBL, and HBL in the DLED group were less than those in the UBED group ( P < 0.05). Postoperative VAS scores and ODI scores showed significant decreases in both groups compared to preoperative scores ( P 0.05). Additionally, no notable differences were observed in the modified MacNab criteria. CONCLUSION UBED and DLED are two minimally invasive techniques that have demonstrated significant effectiveness and safety in the treatment of LDH. However, the DLED group exhibits certain advantages over the UBED group, particularly regarding operation time, blood loss, and soft tissue damage. Delta large-channel endoscopic discectomy Unilateral biportal endoscopic discectomy lumbar disc herniation clinical efficacy and safety Figures Figure 1 Figure 2 Introduction Lumbar disc herniation (LDH) is a common condition in spinal surgery, characterized by symptoms such as low back pain and sciatica. Although non-surgical treatment remains the primary approach, discectomy is an effective treatment option for patients with severe nerve root compression who do not respond to conservative management [ 1 ] . With the development of endoscopic technology, minimally invasive spinal surgery technology has been widely used to treat LDH [ 2 , 3 ] . The interlaminar endoscopic surgical system (iLESSYS), developed by Joimax, is widely utilized and has demonstrated favorable outcomes. Within this system, the Delta subsystem, originally designed for lumbar spinal stenosi, has been adapted by some researchers for the treatment of complex LDH cases [ 4 ] .Delta large-channel endoscopic discectomy (DLED) employs a single-port endoscope, distinguished by its larger working cannulas and endoscopic instruments compared to other single-axis water-medium channels. By utilizing an interlaminar approach, DLED offers advantages such as higher operative efficiency, a broader exploration range, and more effective decompression [ 5 ] . In contrast, unilateral biportal endoscopic discectomy (UBED) adopts a conventional arthroscopic system, with anatomical pathways and endoscopic imaging comparable to traditional discectomy [ 6 ] . This technique can be performed with the assistance of most standard open surgical instruments, and its dual-portal design provides enhanced flexibility and broader visualization. As cutting-edge techniques in minimally invasive spinal endoscopy, both Delta large-channel endoscopy and UBED possess distinct technical attributes. To date, no comparative studies have evaluated these two approaches. This study aims to compare the efficacy and safety of DLED and UBED in the treatment of single-segment lumbar disc herniation. Methods A retrospective case analysis was conducted on 74 LDH patients treated with DLED (39 cases) and UBED (35 cases) from January 2023 to January 2024 at the Department of orthopedics, Nanjing Jinling Hospital. The patients were divided into 2 groups: DLED and UBED. The surgeries of the two groups of patients were performed by the same experienced surgical team. The inclusion criteria included the following: (1) Single-level disc herniation at the L4/L5, and L5/S1 levels; (2) Ineffective conservative treatment after 3 months; (3) Herniation confirmed by MRI and CT The situation is consistent with related nerve root symptoms and signs; (4) Follow-up is at least 6 months. The exclusion criteria included the following: (1) patients with multi-level disc herniation, cauda equina syndrome, lumbar spinal stenosis, spinal metastatic disease or spondylolisthesis; (2) individuals with bleeding tendencies; (3) patients who were lost to follow-up; (4) Patients with recurrent lumbar disc herniation and previous lumbar spine surgery at adjacent segments. This study was approved by the hospital ethics committee, and all patients and their families gave informed consent and signed informed consent forms. SURGICAL PROCEDURES DLED Determine the responsible intervertebral space based on anteroposterior and lateral X-rays, and probe the lower edge of the lamina and the inner edge of the articular process with a long injection needle. The responsible segment is determined by lateral fluoroscopy, and the puncture point is located at the lower edge of the vertebral lamina and the inner edge of the inferior facet joint on anteroposterior fluoroscopy. Make an incision about 1cm long 1.5cm next to the spinous process, place the stepwise expansion tube and threaded working cannula, confirm the channel position through fluoroscopy again, and install the endoscope system ( iLESSYS Delta，Joimax, Germany). Bipolar radiofrequency is used to remove soft tissue and bleeding points, and expose the lower edge of the upper lamina and the ligamentum flavum. Combined with a microscopic trephine and a drill, the lower edge of the lamina and the inner edge of the inferior articular process are removed, and the ligamentum flavum is incised to expose the dural sac. and nerve roots. Explore from the outside of the nerve root, use a tongue-shaped protective tube to push the nerve root inward, and explore and remove the compressive objects one by one. Endoscopic observation showed no active bleeding, and the dura mater and nerve roots pulsed well and relaxed. The endoscope was withdrawn and the incision was sutured layer by layer. UBED A horizontal line is drawn at the body surface projection of the lower end plate of the superior vertebral body, and a vertical line is marked at the medial edge of the pedicle surface projection on the symptomatic side of the affected vertebral body, positioned 1.5 cm cephalad and caudally from their intersection. Horizontal incision marks are made at each location. A sharp knife is then used to create an incision at the marked positions, followed by the insertion of a positioning guide rod to confirm the target intervertebral space through fluoroscopy. The two portals are gradually expanded to the lamina until they intersect, at which point a half-cannula channel is inserted. An endoscope is placed on one side and perfused. Once the view under the microscope is clear, a plasma knife head is positioned on the opposite side to separate the tissue and fully expose the intervertebral space, including the lower third of the upper lamina and the lower third of the lower lamina. A drill is employed to remove a portion of the bone at the lower edge of the upper lamina and the upper edge of the lower lamina, thereby exposing the attachment of the ligamentum flavum. The ligamentum flavum is then excised to reveal the dural sac and nerve roots. Careful dissection is performed to separate the adhesive tissue around the nerve root, allowing for the retraction of the nerve root and dura mater to the opposite side, which exposes the herniated intervertebral disc. The compressive objects are removed, and a thorough exploration is conducted to ensure there are no residual fragments and no active bleeding. Finally, a drainage tube is inserted, and the incision is closed with sutures. Postoperative treatment In the UBED group, the drainage was removed within 24 hours after surgery, but in the Delta endoscopy group, no drainage was placed. All patients wore waist protection when out of bed after surgery. Within 6 weeks after surgery, patients should avoid weight-bearing activities and perform moderate waist muscle function exercises. Observation Indicators and Methods The main observation indicators record preoperative baseline data, perioperative indicators, and preoperative and postoperative clinical efficacy evaluation, including the number of fluoroscopy times, operation time, intraoperative blood loss (IBL), hematological indicators, follow-up time, and complications. Preoperative blood volume (PBV) was calculated according to Nadler formula: PBV = k1 × height(m) 3 + k2 × weight(kg) + k3 (for men: k1 = 0.3669, k2 = 0.03219, k3= 0.6041; Female: k1 = 0.3561, k2 = 0.03308, and k3 = 0.1833.). Total blood loss (TBL) is calculated according to the Gross formula: TBL = PBV × (HCTpre−HCTpost)/HCTave. Hidden blood loss (HBL) is calculated according to the following formula: HBL = TBL-IBL-postoperative drainage volume. The clinical effect was evaluated according to the pain visual analogue scale (VAS), Oswestry disability index (ODI) and modified Macnab criteria. Statistical analysis All statistical analyses were performed using SPSS software. (Version 25, Chicago, IL, USA). Intergroup comparisons were employed using independent samples t -test, Chi-Square tests and Mann–Whitney U tests; Intragroup comparisons were conducted using paired t test. Comparisons with values of P < 0.05 were considered statistically significant. Results General information A total of 74 patients in DLED (39 cases) and UBED (35 cases) met the inclusion criteria, No complications such as nerve injury, dural injury, and infection were found during the follow-up period. There were no statistically significant differences observed in terms of gender, age, body mass index (BMI), follow-up time, and disc herniation classification between the two groups ( P > 0.05). (Table 1 ). Table 1 Comparison of general data between the two groups Cases Age BMI (kg/m 2 ) Follow-up Duration(Months) Gender Segment Male Female L4/5 L5/S1 DLED 39 47.56 ± 13.95 24.35 ± 2.96 9.64 ± 2.28 20 19 18 21 UBED 35 45.77 ± 13.71 25.21 ± 3.26 9.54 ± 2.44 15 20 22 13 t/χ 2 value -0.557 1.180 -0.179 0.525 2.072 P value 0.580 0.242 0.858 0.469 0.150 Perioperative outcomes Compared with DLED group, UBED group was associated with more Hb loss, more Hct loss, longer operation time, and higher CK level ( P < 0.001). The total blood loss (TBL) in the Delta endoscopic group was significantly lower than that in the UBED group ( P < 0.01). Additionally, a statistically significant difference in intraoperative blood loss (IBL) was noted, with the UBED group exhibiting substantially greater hidden blood loss (HBL) compared to the control group ( P < 0.05). (Table 2 ). Table 2 Comparison of surgical indexes in patients between the two groups DLED UBED t value P value Cases 39 35 Fluoroscopy Procedures 3.15 ± 1.16 3.03 ± 1.07 -0.481 0.632 Surgical Duration (min) 83.97 ± 18.40 94.29 ± 12.55 2.840 0.006* IBL (ml) 58.33 ± 11.22 69.43 ± 18.82 3.037 0.004* Preoperative Hb(g/L) 134.08 ± 14.00 131.40 ± 15.50 -0.781 0.438 Postoperative Hb(g/L) 129.56 ± 14.09 121.77 ± 16.04 -2.225 0.029* Hb Loss (g/L) 4.51 ± 2.80 9.63 ± 5.93 4.658 0.000* Preoperative HCT(%) 43.77 ± 3.20 42.69 ± 3.96 -1.300 0.198 Postoperative HCT(%) 41.46 ± 3.56 39.34 ± 3.76 -2.487 0.015* HCT Loss (%) 2.31 ± 1.49 3.34 ± 1.39 3.078 0.003* Preoperative CK(U/L) 57.05 ± 10.50 59.63 ± 10.53 1.053 0.296 Postoperative CK(U/L) 102.33 ± 12.87 120.54 ± 19.05 4.762 0.000* PBV(L) 4.41 ± 0.72 4.35 ± 0.77 -0.384 0.702 TBL(ml) 236.70 ± 152.52 356.32 ± 164.84 3.242 0.002* HBL(ml) 178.36 ± 154.13 267.86 ± 160.82 2.443 0.017* Clinical outcomes There was no statistically significant difference in the preoperative VAS scores and ODI for low back pain and sciatica between the two groups. However, both groups demonstrated a significant reduction in postoperative VAS scores and ODI compared to their preoperative scores ( P < 0.05). According to the MacNab standard, patient satisfaction rates were 88.57% in the UBED group and 89.74% in the DLED group, with no statistically significant difference in satisfaction between the two groups ( P > 0.05). (Table 3 ). Table 3 Comparison of clinical efficacy evaluation between the two groups. DLED UBED t value P value Low Back Pain Preoperative 6.69 ± 1.22 6.54 ± 1.12 -0.547 0.586 Postoperative Day 1 2.44 ± 1.02 2.34 ± 0.94 -0.407 0.685 Postoperative 3 Months 0.67 ± 0.48 0.71 ± 0.57 0.390 0.698 Postoperative 6 Months 0.38 ± 0.49 0.40 ± 0.49 0.134 0.894 Sciatica Preoperative 7.13 ± 1.36 7.23 ± 1.03 0.354 0.724 Postoperative Day 1 1.67 ± 0.87 1.74 ± 0.82 0.387 0.700 Postoperative 3 Months 0.49 ± 0.51 0.66 ± 0.48 1.479 0.143 Postoperative 6 Months 0.31 ± 0.47 0.43 ± 0.50 1.072 0.287 ODI Preoperative 69.49 ± 12.45 67.43 ± 13.24 -0.689 0.493 Postoperative Day 1 23.74 ± 7.29 24.69 ± 6.77 0.574 0.568 Postoperative 3 Months 9.69 ± 4.74 9.31 ± 4.68 -0.345 0.731 Postoperative 6 Months 2.41 ± 1.96 2.69 ± 2.42 0.540 0.591 Modified MacNab Classification (Excellent/Good/Fair/Poor) 25/10/4/0 22/9/3/1 Excellent Rate 89.74% 88.57% 0.871 Discussion Lumbar disc herniation is the most common cause of low back pain and sciatica, affecting 1%-5% of the population every year, and its prevalence is increasing year by year, with a trend among younger people [ 7 ] . As an alternative to ineffective conservative treatment, discectomy has evolved with the advancement of minimally invasive spinal endoscopy and the concept of rapid recovery, making minimally invasive spine surgery a mainstream therapeutic approach. Around 2000, Yeung and Hoogland developed the Yeung Endoscopic Spine System (YESS) and the Transforaminal Endoscopic Spine System (TESSYS) technologies respectively. These two techniques constituted percutaneous endoscopic transforaminal discectomy (PETD), which subsequently evolved into percutaneous endoscopic interlaminar discectomy (PEID). Percutaneous endoscopic lumbar discectomy (PELD) can produce good long-term results and has become a representative minimally invasive spine surgical technique for the treatment of lumbar disc herniation (LDH) [ 8 ] . The commonly used endoscope has a diameter of 7.5 mm, the operating range through the intervertebral foramen or interlaminar is relatively limited, and the work efficiency is low. When the endoscope is used to treat the high iliac crest [ 9 ] , the surgical approach is limited by the high iliac crest and the hypertrophied L5 transverse process. The impact makes it difficult for puncture to reach the lumbar disc herniation site. Posterior interlaminar disc nucleus pulposus removal can effectively avoid the problems encountered in lateral surgery, but posterior surgery will inevitably have an impact on the posterior spinal muscles, especially the multifidus. The introduction of minimally invasive endoscopic technology can undoubtedly reduce intraoperative muscle dissection and denervation of corresponding muscle groups, which is more conducive to patients postoperative functional recovery. Paravertebral muscle integrity is thought to play a key role in low back pain and many spinal deformity disorders and other pain pathologies [ 10 ] . Antoni first described the use of UBE technique for the treatment of lumbar disc herniation in 1966 [ 11 ] , and since then, this technique has been rapidly applied in recent years, similar to open discectomy. It uses an arthroscopic system to treat lumbar disc herniation. By combining the observation channel and the operating channel, it expands the range of movement of the operation, thereby achieving better decompression effect and detection range, and is even used in cases of spinal stenosis. However, its drawbacks include: the use of two channels increases tissue damage, the operating space is large with poor sealing, making hemostasis challenging; when using water as the medium, excessive bleeding during surgery can obscure the field of view, thereby increasing the risk of dural and nerve root damage [ 12 ] . The Delta large channel is a single-hole endoscope, Compared with UBE, the single-hole endoscope has less muscle dissection and can flexibly adjust the direction of the endoscope according to the direction of the nucleus pulposus protrusion to reach the protrusion site [ 13 ] ; ​​compared with the transforaminal endoscope, The diameter of the endoscope reaches 10 mm, the field of view under the endoscope is wider, and it is highly maneuverable. It can minimize iatrogenic damage, and the precise removal and decompression of prominent nucleus pulposus tissue is more thorough, improving work efficiency. And the tubular channel is used for orderly tissue expansion, allowing precise access to the surgical area for surgery, preserving the entire posterior paravertebral musculature, and minimizing trauma [ 14 – 16 ] . Furthermore, the presence of a large operational space, coupled with minimal damage to the muscle attachment points and joint capsule of the surgical segment, significantly reduces the risk of postoperative low back pain [ 17 , 18 ] . Previous studies have suggested that both DLED and UBED are effective minimally invasive surgical techniques for treating lumbar disc herniation and can also be used to manage more complex cases of lumbar spinal stenosis. Compared to other minimally invasive techniques utilizing water- or air-based media, these two approaches offer advantages such as improved surgical efficiency and a clearer operative field. However, to date, no comparative studies have been conducted between these two techniques. This study aims to evaluate and compare the efficacy and safety of DLED and UBED in the treatment of single-level lumbar disc herniation. Compared with the DLED group in this study, the operation duration of the UBED group was significantly longer. We believe that there are two main reasons: 1. The learning curve for UBE technology remains steep, with creating an operating space and identifying specific anatomical landmarks as the main difficulties.; 2. The intraoperative bleeding hemostasis operation takes a long time, and the intraoperative bleeding volume is larger than that of the DLED group [ 19 , 20 ] . Although the changes in HB and HCT after surgery were not obvious, the loss of Hb and Hct proved it from the side. Previous studies have shown that there is a relationship between CK levels and the pressure exerted on paravertebral muscles [ 21 ] . Serum CK concentration can be used as an effective indicator of muscle damage, and the increase in its level is closely related to the invasiveness of surgery [ 22 ] . In our study, the CK levels of both groups increased significantly on the first day after surgery, especially in the UBED group. We believe that the DLED group uses the stepwise expansion channel muscle splitting technology to directly reach the target location, thereby maintaining the integrity of the paravertebral muscles and causing less muscle damage [ 12 , 23 ] . The study comparing the PELD group with the UBE group found that the HBL of the PELD group was significantly lower than that of the UBE group, mainly because in the UBE technique, partial laminectomy may cause cancellous bone bleeding [ 20 , 24 ] . In our study, DELTA large-channel endoscope was used, and part of the lower edge of the lamina and the inner edge of the inferior articular process also needed to be removed during the operation, If excessive bleeding occurs from the bony surface, bone wax can be utilized to attain hemostasis [ 25 ] . The results of the study found that the hidden blood loss in the UBED group was higher than that in the DLED group, We believe that the additional channels used in UBE technology will cause greater damage to soft tissues, increase perioperative bleeding, and then lead to an increase in HBL [ 26 , 27 ] . In addition, prolonged UBE surgery will increase the possibility of interstitial leakage, making it easier for blood to spread into the interstitial space, thereby further aggravating the degree of HBL [ 24 ] . In addition, the calculation method of intraoperative blood loss mainly includes estimating based on the difference between the amount of fluid aspirated and the amount of saline flushed, and the amount of blood absorbed by the gauze also needs to be considered. Although this method is widely used in most settings, it may itself introduce a degree of bias. Therefore, the actual hidden blood loss (HBL) is often underestimated due to the bias introduced by these estimation methods. Our results indicate that the VAS and ODI scores at each observation point following surgery in both groups were significantly lower than those recorded prior to surgery. Furthermore, these indicators showed a progressive improvement during the follow-up period, leading to high levels of patient satisfaction and the absence of notable complications. These findings suggest that both minimally invasive surgical techniques are effective in treating lumbar disc herniation with regard to safety and efficacy. Conclusion In summary, UBE and Delta large-channel endoscopic surgery show considerable efficacy and safety in reducing pain and improving function in patients with LDH. However, compared with UBED, DLED has certain advantages in terms of operation time, blood loss, and soft tissue damage. This study has several limitations. First, this study was a retrospective study with a relatively small sample size and lack of randomized design, so some potential biases may not be completely ruled out. In addition, given the short follow-up time of this study, further mid- and long-term follow-up observations are needed to obtain more comprehensive and reliable data. Abbreviations LDH Lumbar disc herniation DLED Delta large-channel endoscopic discectomy UBED Unilateral biportal endoscopic discectomy VAS Visual Analog Scale ODI Oswestry Disability Index VAS Visual Analog Scale Declarations Acknowledgements The authors would like to thank all the reviewers and editors who participated in the review. Data availability All data generated or analyzed during this study are included in this published article and are available from the corresponding author on reasonable request. Clinical trial number Not applicable. Ethics declarations Ethics approval and consent to participate This material has not been published and is not under consideration elsewhere. This study is approved by the Medical Ethics Committee of the Nanjing Jinling Hospita. All authors have confirmed that all methods were performed in accordance with the relevant guidelines and regulations. This study obtained the informed consent of all patients or their legal guardians, and all patients or their legal guardians agreed to participate in this study. This study adhered to the Declaration of Helsinki. Consent for publication Not Applicable. Authors' contributions Guodong Guo and Yang Qiu : Conceptualization, Methodology, Validation, Formal analysis, Investigation, Data curation, Writing – original draft, Writing – review & editing, Visualization. Suohua Pan : Validation, Formal analysis, Investigation. Daokuan Gao : Data curation,Methodology, Writing – review & editing. Huijuan Ma and Gang Liu : Conceptualization, Writing – review & editing, Supervision, Project administration, Funding acquisition. Huijuan Ma and Gang Liu contributed equally to this work are joint corresponding authors. Funding This study was supported by the 2023 Life and Health Technology Special Project of Nanjing [grant number 202305018]. Competing interests The authors declare no competing interests. References Yoon WW, Koch J. Herniated discs: when is surgery necessary?. EFORT Open Rev . 2021;6(6):526-530. Published 2021 Jun 28. doi:10.1302/2058-5241.6.210020 Kanno H, Aizawa T, Hahimoto K, Itoi E. Minimally invasive discectomy for lumbar disc herniation: current concepts, surgical techniques, and outcomes. Int Orthop . 2019;43(4):917-922. doi:10.1007/s00264-018-4256-5 Qin, Lu et al. A Comparison of Minimally Invasive Surgical Techniques and Standard Open Discectomy for Lumbar Disc Herniation: A Network Meta-analysis. Pain Physician . 2024;27(3): E305-E316. Meng SW, et al. 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Hidden blood loss and its risk factors in percutaneous vertebroplasty surgery for osteoporotic vertebral compression fractures. Arch Orthop Trauma Surg . 2023;143(9):5575-5581. doi:10.1007/s00402-023-04873-3 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Reviewers agreed at journal 30 May, 2025 Reviewers invited by journal 21 May, 2025 Editor invited by journal 29 Apr, 2025 Editor assigned by journal 28 Apr, 2025 Submission checks completed at journal 28 Apr, 2025 First submitted to journal 23 Apr, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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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-6512924","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":459919078,"identity":"e1cdd1e4-93d8-431f-86ab-2325c5d7cf3a","order_by":0,"name":"Guodong Guo","email":"","orcid":"","institution":"Nanjing University","correspondingAuthor":false,"prefix":"","firstName":"Guodong","middleName":"","lastName":"Guo","suffix":""},{"id":459919079,"identity":"169b8356-e82b-46da-8842-4d8a54b4abd4","order_by":1,"name":"Yang Qiu","email":"","orcid":"","institution":"Nanjing University","correspondingAuthor":false,"prefix":"","firstName":"Yang","middleName":"","lastName":"Qiu","suffix":""},{"id":459919080,"identity":"53f76c13-7799-4a0c-95ff-e55b6c9208f1","order_by":2,"name":"Suohua Pan","email":"","orcid":"","institution":"Nanjing University","correspondingAuthor":false,"prefix":"","firstName":"Suohua","middleName":"","lastName":"Pan","suffix":""},{"id":459919081,"identity":"31d53852-4642-43ba-a679-784e7eb71021","order_by":3,"name":"Daokuan Gao","email":"","orcid":"","institution":"Nanjing University","correspondingAuthor":false,"prefix":"","firstName":"Daokuan","middleName":"","lastName":"Gao","suffix":""},{"id":459919082,"identity":"aa3e6d86-ed89-4792-a72b-7eb4fcf43d43","order_by":4,"name":"Huijuan Ma","email":"","orcid":"","institution":"Nanjing Medical University","correspondingAuthor":false,"prefix":"","firstName":"Huijuan","middleName":"","lastName":"Ma","suffix":""},{"id":459919083,"identity":"5e8a98fc-0d95-41aa-9b6a-3417546268d3","order_by":5,"name":"Gang Liu","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA5klEQVRIiWNgGAWjYBACPmYg8cFAQo4BwrCRI6iFDaiScUaFjTEDmFGQZkxYCxAz85xJS2wAMz4cTiSshZ3H+AVv22HGDceZnz22MWBOYGA/fHQDfofxmFlIth1mlmxmMzfOMWDLY+BJS7tBSIuBYdthNn5mBjPpHAOeYgYJHjPCWhLbDvOwMbN/k7YwkEhsIEKL8YMDZ9Ik+IF6pRkMDIjRwlbG2FBhYyDZzFMm2WOQYMxGyC/8/Ic3f/5jIFG/4fzxbRI//vyX42c/fAyvFpBFEqhcAspBgPkDEYpGwSgYBaNgJAMA+bA9tefB2u0AAAAASUVORK5CYII=","orcid":"","institution":"Nanjing University","correspondingAuthor":true,"prefix":"","firstName":"Gang","middleName":"","lastName":"Liu","suffix":""}],"badges":[],"createdAt":"2025-04-23 13:08:24","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6512924/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6512924/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":83420933,"identity":"ab523a79-aa2d-4436-9745-57c6f7e54796","added_by":"auto","created_at":"2025-05-26 01:56:49","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":596851,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eA 36-year-old male with L5/S1 disc herniation, undergoing Delta large-channel endoscopic discectomy via a percutaneous interlaminar approach.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA-B. Preoperative sagittal and axial MRI showing left-sided L5-S1 disc herniation. C. Intraoperative image showing placement of the DLED catheter. D. Intraoperative image of DLED. E. Endoscopic image showing relaxation of the S1 nerve root after decompression. F-G. Postoperative sagittal and axial MRI images taken 6 months later, indicating adequate decompression.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-6512924/v1/7a18bca9fd1162abdf583d7f.png"},{"id":83421212,"identity":"783696ad-38e1-4d3a-b081-7f05c15a8eb5","added_by":"auto","created_at":"2025-05-26 02:04:49","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":501403,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eA 47-year-old male with L5/S1 disc herniation who underwent Unilateral biportal endoscopic discectomy.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA-B. Preoperative sagittal and axial MRI showing right-sided L5-S1 disc herniation. C. Intraoperative image showing placement of the UBED catheter. D. Intraoperative image of UBED. E. Endoscopic image showing relaxation of the S1 nerve root after decompression. F-G. Postoperative sagittal and axial MRI images taken 6 months later, indicating adequate decompression.\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-6512924/v1/cb9ffd631668bbb46c1a6d1e.png"},{"id":83421664,"identity":"3097cb2c-a2a0-45f8-a9d6-a99f51f507a8","added_by":"auto","created_at":"2025-05-26 02:12:50","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2177758,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6512924/v1/5c8b2216-9ca2-45d1-8e63-a77c91b41c93.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eDelta large-channel endoscopic discectomy versus Unilateral biportal endoscopic discectomy in the treatment of lumbar disc herniation: A Retrospective Study\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eLumbar disc herniation (LDH) is a common condition in spinal surgery, characterized by symptoms such as low back pain and sciatica. Although non-surgical treatment remains the primary approach, discectomy is an effective treatment option for patients with severe nerve root compression who do not respond to conservative management\u003csup\u003e[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]\u003c/sup\u003e. With the development of endoscopic technology, minimally invasive spinal surgery technology has been widely used to treat LDH \u003csup\u003e[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]\u003c/sup\u003e. The interlaminar endoscopic surgical system (iLESSYS), developed by Joimax, is widely utilized and has demonstrated favorable outcomes. Within this system, the Delta subsystem, originally designed for lumbar spinal stenosi, has been adapted by some researchers for the treatment of complex LDH cases\u003csup\u003e[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]\u003c/sup\u003e.Delta large-channel endoscopic discectomy (DLED) employs a single-port endoscope, distinguished by its larger working cannulas and endoscopic instruments compared to other single-axis water-medium channels. By utilizing an interlaminar approach, DLED offers advantages such as higher operative efficiency, a broader exploration range, and more effective decompression \u003csup\u003e[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]\u003c/sup\u003e. In contrast, unilateral biportal endoscopic discectomy (UBED) adopts a conventional arthroscopic system, with anatomical pathways and endoscopic imaging comparable to traditional discectomy \u003csup\u003e[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]\u003c/sup\u003e. This technique can be performed with the assistance of most standard open surgical instruments, and its dual-portal design provides enhanced flexibility and broader visualization. As cutting-edge techniques in minimally invasive spinal endoscopy, both Delta large-channel endoscopy and UBED possess distinct technical attributes. To date, no comparative studies have evaluated these two approaches. This study aims to compare the efficacy and safety of DLED and UBED in the treatment of single-segment lumbar disc herniation.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eA retrospective case analysis was conducted on 74 LDH patients treated with DLED (39 cases) and UBED (35 cases) from January 2023 to January 2024 at the Department of orthopedics, Nanjing Jinling Hospital. \u0026nbsp;The patients were divided into 2 groups: DLED and UBED. The surgeries of the two groups of patients were performed by the same experienced surgical team. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe inclusion criteria included the following: (1) Single-level disc herniation at the L4/L5, and L5/S1 levels; (2) Ineffective conservative treatment after 3 months; (3) Herniation confirmed by MRI and CT The situation is consistent with related nerve root symptoms and signs; (4) Follow-up is at least 6 months. \u003c/p\u003e\n\u003cp\u003eThe exclusion criteria included the following: (1) patients with multi-level disc herniation, cauda equina syndrome, lumbar spinal stenosis, spinal metastatic disease or spondylolisthesis; (2) individuals with bleeding tendencies; (3) patients who were lost to follow-up; (4) Patients with recurrent lumbar disc herniation and previous lumbar spine surgery at adjacent segments.\u003c/p\u003e\n\u003cp\u003eThis study was approved by the hospital ethics committee, and all patients and their families gave informed consent and signed informed consent forms.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSURGICAL PROCEDURES\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDLED\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDetermine the responsible intervertebral space based on anteroposterior and lateral X-rays, and probe the lower edge of the lamina and the inner edge of the articular process with a long injection needle. \u0026nbsp;The responsible segment is determined by lateral fluoroscopy, and the puncture point is located at the lower edge of the vertebral lamina and the inner edge of the inferior facet joint on anteroposterior fluoroscopy. \u0026nbsp; Make an incision about 1cm long 1.5cm next to the spinous process, place the stepwise expansion tube and threaded working cannula, confirm the channel position through fluoroscopy again, and install the endoscope system\u003cstrong\u003e(\u003c/strong\u003eiLESSYS Delta，Joimax, Germany). Bipolar radiofrequency is used to remove soft tissue and bleeding points, and expose the lower edge of the upper lamina and the ligamentum flavum. \u0026nbsp;Combined with a microscopic trephine and a drill, the lower edge of the lamina and the inner edge of the inferior articular process are removed, and the ligamentum flavum is incised to expose the dural sac. and nerve roots. \u0026nbsp;Explore from the outside of the nerve root, use a tongue-shaped protective tube to push the nerve root inward, and explore and remove the compressive objects one by one. Endoscopic observation showed no active bleeding, and the dura mater and nerve roots pulsed well and relaxed. \u0026nbsp;The endoscope was withdrawn and the incision was sutured layer by layer.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eUBED\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA horizontal line is drawn at the body surface projection of the lower end plate of the superior vertebral body, and a vertical line is marked at the medial edge of the pedicle surface projection on the symptomatic side of the affected vertebral body, positioned 1.5 cm cephalad and caudally from their intersection. Horizontal incision marks are made at each location. A sharp knife is then used to create an incision at the marked positions, followed by the insertion of a positioning guide rod to confirm the target intervertebral space through fluoroscopy. The two portals are gradually expanded to the lamina until they intersect, at which point a half-cannula channel is inserted. An endoscope is placed on one side and perfused. Once the view under the microscope is clear, a plasma knife head is positioned on the opposite side to separate the tissue and fully expose the intervertebral space, including the lower third of the upper lamina and the lower third of the lower lamina. A drill is employed to remove a portion of the bone at the lower edge of the upper lamina and the upper edge of the lower lamina, thereby exposing the attachment of the ligamentum flavum. The ligamentum flavum is then excised to reveal the dural sac and nerve roots. Careful dissection is performed to separate the adhesive tissue around the nerve root, allowing for the retraction of the nerve root and dura mater to the opposite side, which exposes the herniated intervertebral disc. The compressive objects are removed, and a thorough exploration is conducted to ensure there are no residual fragments and no active bleeding. Finally, a drainage tube is inserted, and the incision is closed with sutures.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePostoperative treatment\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn the UBED group, the drainage was removed within 24 hours after surgery, but in the Delta endoscopy group, no drainage was placed. \u0026nbsp;All patients wore waist protection when out of bed after surgery. \u0026nbsp; Within 6 weeks after surgery, patients should avoid weight-bearing activities and perform moderate waist muscle function exercises.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eObservation Indicators and Methods\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe main observation indicators record preoperative baseline data, perioperative indicators, and preoperative and postoperative clinical efficacy evaluation, including the number of fluoroscopy times, operation time, intraoperative blood loss (IBL), hematological indicators, follow-up time, and complications. Preoperative blood volume (PBV) was calculated according to Nadler formula: PBV = k1 \u0026times; height(m)\u003csup\u003e3\u003c/sup\u003e + k2 \u0026times; weight(kg) + k3 (for men: k1 = 0.3669, k2 = 0.03219, k3= 0.6041; Female: k1 = 0.3561, k2 = 0.03308, and k3 = 0.1833.). \u0026nbsp; Total blood loss (TBL) is calculated according to the Gross formula: TBL = PBV \u0026times; (HCTpre\u0026minus;HCTpost)/HCTave. Hidden blood loss (HBL) is calculated according to the following formula: HBL = TBL-IBL-postoperative drainage volume. \u0026nbsp;The clinical effect was evaluated according to the pain visual analogue scale (VAS), Oswestry disability index (ODI) and modified Macnab criteria.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStatistical analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll statistical analyses were performed using SPSS software. (Version 25, Chicago, IL, USA). \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIntergroup comparisons were employed using independent samples \u003cem\u003et\u003c/em\u003e-test, Chi-Square tests and Mann\u0026ndash;Whitney U tests; Intragroup comparisons were conducted using paired \u003cem\u003et\u003c/em\u003e test. Comparisons with values of \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05 were considered statistically significant.\u003c/p\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003eGeneral information\u003c/h2\u003e \u003cp\u003eA total of 74 patients in DLED (39 cases) and UBED (35 cases) met the inclusion criteria, No complications such as nerve injury, dural injury, and infection were found during the follow-up period. There were no statistically significant differences observed in terms of gender, age, body mass index (BMI), follow-up time, and disc herniation classification between the two groups (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05). (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e\u003cb\u003eComparison of general data between the two groups\u003c/b\u003e\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"9\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eCases\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eBMI (kg/m\u003csup\u003e2\u003c/sup\u003e)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eFollow-up Duration(Months)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e \u003cp\u003eSegment\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eL4/5\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003eL5/S1\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDLED\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e47.56\u0026thinsp;\u0026plusmn;\u0026thinsp;13.95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e24.35\u0026thinsp;\u0026plusmn;\u0026thinsp;2.96\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e9.64\u0026thinsp;\u0026plusmn;\u0026thinsp;2.28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUBED\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e45.77\u0026thinsp;\u0026plusmn;\u0026thinsp;13.71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e25.21\u0026thinsp;\u0026plusmn;\u0026thinsp;3.26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e9.54\u0026thinsp;\u0026plusmn;\u0026thinsp;2.44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003et/χ\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.557\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.180\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.179\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e0.525\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e \u003cp\u003e2.072\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.580\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.242\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.858\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e0.469\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e \u003cp\u003e0.150\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003ePerioperative outcomes\u003c/h2\u003e \u003cp\u003eCompared with DLED group, UBED group was associated with more Hb loss, more Hct loss, longer operation time, and higher CK level (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). The total blood loss (TBL) in the Delta endoscopic group was significantly lower than that in the UBED group (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01). Additionally, a statistically significant difference in intraoperative blood loss (IBL) was noted, with the UBED group exhibiting substantially greater hidden blood loss (HBL) compared to the control group (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05). (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of surgical indexes in patients between the two groups\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDLED\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eUBED\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003et\u003c/em\u003e value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCases\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFluoroscopy Procedures\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.15\u0026thinsp;\u0026plusmn;\u0026thinsp;1.16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.03\u0026thinsp;\u0026plusmn;\u0026thinsp;1.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.481\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.632\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSurgical Duration (min)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e83.97\u0026thinsp;\u0026plusmn;\u0026thinsp;18.40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e94.29\u0026thinsp;\u0026plusmn;\u0026thinsp;12.55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.840\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.006*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIBL (ml)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e58.33\u0026thinsp;\u0026plusmn;\u0026thinsp;11.22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e69.43\u0026thinsp;\u0026plusmn;\u0026thinsp;18.82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.037\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.004*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePreoperative Hb(g/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e134.08\u0026thinsp;\u0026plusmn;\u0026thinsp;14.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e131.40\u0026thinsp;\u0026plusmn;\u0026thinsp;15.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.781\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.438\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePostoperative Hb(g/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e129.56\u0026thinsp;\u0026plusmn;\u0026thinsp;14.09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e121.77\u0026thinsp;\u0026plusmn;\u0026thinsp;16.04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-2.225\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.029*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHb Loss (g/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.51\u0026thinsp;\u0026plusmn;\u0026thinsp;2.80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9.63\u0026thinsp;\u0026plusmn;\u0026thinsp;5.93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4.658\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.000*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePreoperative HCT(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e43.77\u0026thinsp;\u0026plusmn;\u0026thinsp;3.20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e42.69\u0026thinsp;\u0026plusmn;\u0026thinsp;3.96\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-1.300\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.198\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePostoperative HCT(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e41.46\u0026thinsp;\u0026plusmn;\u0026thinsp;3.56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e39.34\u0026thinsp;\u0026plusmn;\u0026thinsp;3.76\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-2.487\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.015*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHCT Loss (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.31\u0026thinsp;\u0026plusmn;\u0026thinsp;1.49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.34\u0026thinsp;\u0026plusmn;\u0026thinsp;1.39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.078\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.003*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePreoperative CK(U/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e57.05\u0026thinsp;\u0026plusmn;\u0026thinsp;10.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e59.63\u0026thinsp;\u0026plusmn;\u0026thinsp;10.53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.053\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.296\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePostoperative CK(U/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e102.33\u0026thinsp;\u0026plusmn;\u0026thinsp;12.87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e120.54\u0026thinsp;\u0026plusmn;\u0026thinsp;19.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4.762\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.000*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePBV(L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.41\u0026thinsp;\u0026plusmn;\u0026thinsp;0.72\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.35\u0026thinsp;\u0026plusmn;\u0026thinsp;0.77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.384\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.702\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTBL(ml)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e236.70\u0026thinsp;\u0026plusmn;\u0026thinsp;152.52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e356.32\u0026thinsp;\u0026plusmn;\u0026thinsp;164.84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.242\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.002*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHBL(ml)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e178.36\u0026thinsp;\u0026plusmn;\u0026thinsp;154.13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e267.86\u0026thinsp;\u0026plusmn;\u0026thinsp;160.82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.443\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.017*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eClinical outcomes\u003c/h2\u003e \u003cp\u003eThere was no statistically significant difference in the preoperative VAS scores and ODI for low back pain and sciatica between the two groups. However, both groups demonstrated a significant reduction in postoperative VAS scores and ODI compared to their preoperative scores (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05). According to the MacNab standard, patient satisfaction rates were 88.57% in the UBED group and 89.74% in the DLED group, with no statistically significant difference in satisfaction between the two groups (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05). (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of clinical efficacy evaluation between the two groups.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDLED\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eUBED\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003et\u003c/em\u003e value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLow Back Pain\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePreoperative\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6.69\u0026thinsp;\u0026plusmn;\u0026thinsp;1.22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6.54\u0026thinsp;\u0026plusmn;\u0026thinsp;1.12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.547\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.586\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePostoperative Day 1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.44\u0026thinsp;\u0026plusmn;\u0026thinsp;1.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.34\u0026thinsp;\u0026plusmn;\u0026thinsp;0.94\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.407\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.685\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePostoperative 3 Months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.67\u0026thinsp;\u0026plusmn;\u0026thinsp;0.48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.71\u0026thinsp;\u0026plusmn;\u0026thinsp;0.57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.390\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.698\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePostoperative 6 Months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.38\u0026thinsp;\u0026plusmn;\u0026thinsp;0.49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.40\u0026thinsp;\u0026plusmn;\u0026thinsp;0.49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.134\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.894\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSciatica\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePreoperative\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7.13\u0026thinsp;\u0026plusmn;\u0026thinsp;1.36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7.23\u0026thinsp;\u0026plusmn;\u0026thinsp;1.03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.354\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.724\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePostoperative Day 1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.67\u0026thinsp;\u0026plusmn;\u0026thinsp;0.87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.74\u0026thinsp;\u0026plusmn;\u0026thinsp;0.82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.387\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.700\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePostoperative 3 Months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.49\u0026thinsp;\u0026plusmn;\u0026thinsp;0.51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.66\u0026thinsp;\u0026plusmn;\u0026thinsp;0.48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.479\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.143\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePostoperative 6 Months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.31\u0026thinsp;\u0026plusmn;\u0026thinsp;0.47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.43\u0026thinsp;\u0026plusmn;\u0026thinsp;0.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.072\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.287\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eODI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePreoperative\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e69.49\u0026thinsp;\u0026plusmn;\u0026thinsp;12.45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e67.43\u0026thinsp;\u0026plusmn;\u0026thinsp;13.24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.689\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.493\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePostoperative Day 1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e23.74\u0026thinsp;\u0026plusmn;\u0026thinsp;7.29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e24.69\u0026thinsp;\u0026plusmn;\u0026thinsp;6.77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.574\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.568\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePostoperative 3 Months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9.69\u0026thinsp;\u0026plusmn;\u0026thinsp;4.74\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9.31\u0026thinsp;\u0026plusmn;\u0026thinsp;4.68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.345\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.731\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePostoperative 6 Months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.41\u0026thinsp;\u0026plusmn;\u0026thinsp;1.96\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.69\u0026thinsp;\u0026plusmn;\u0026thinsp;2.42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.540\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.591\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eModified MacNab Classification (Excellent/Good/Fair/Poor)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e25/10/4/0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e22/9/3/1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eExcellent Rate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e89.74%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e88.57%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.871\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eLumbar disc herniation is the most common cause of low back pain and sciatica, affecting 1%-5% of the population every year, and its prevalence is increasing year by year, with a trend among younger people\u003csup\u003e[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]\u003c/sup\u003e. As an alternative to ineffective conservative treatment, discectomy has evolved with the advancement of minimally invasive spinal endoscopy and the concept of rapid recovery, making minimally invasive spine surgery a mainstream therapeutic approach.\u003c/p\u003e \u003cp\u003eAround 2000, Yeung and Hoogland developed the Yeung Endoscopic Spine System (YESS) and the Transforaminal Endoscopic Spine System (TESSYS) technologies respectively. These two techniques constituted percutaneous endoscopic transforaminal discectomy (PETD), which subsequently evolved into percutaneous endoscopic interlaminar discectomy (PEID). Percutaneous endoscopic lumbar discectomy (PELD) can produce good long-term results and has become a representative minimally invasive spine surgical technique for the treatment of lumbar disc herniation (LDH) \u003csup\u003e[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]\u003c/sup\u003e. The commonly used endoscope has a diameter of 7.5 mm, the operating range through the intervertebral foramen or interlaminar is relatively limited, and the work efficiency is low. When the endoscope is used to treat the high iliac crest \u003csup\u003e[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]\u003c/sup\u003e, the surgical approach is limited by the high iliac crest and the hypertrophied L5 transverse process. The impact makes it difficult for puncture to reach the lumbar disc herniation site. Posterior interlaminar disc nucleus pulposus removal can effectively avoid the problems encountered in lateral surgery, but posterior surgery will inevitably have an impact on the posterior spinal muscles, especially the multifidus. The introduction of minimally invasive endoscopic technology can undoubtedly reduce intraoperative muscle dissection and denervation of corresponding muscle groups, which is more conducive to patients postoperative functional recovery. Paravertebral muscle integrity is thought to play a key role in low back pain and many spinal deformity disorders and other pain pathologies \u003csup\u003e[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eAntoni first described the use of UBE technique for the treatment of lumbar disc herniation in 1966 \u003csup\u003e[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]\u003c/sup\u003e, and since then, this technique has been rapidly applied in recent years, similar to open discectomy. It uses an arthroscopic system to treat lumbar disc herniation. By combining the observation channel and the operating channel, it expands the range of movement of the operation, thereby achieving better decompression effect and detection range, and is even used in cases of spinal stenosis. However, its drawbacks include: the use of two channels increases tissue damage, the operating space is large with poor sealing, making hemostasis challenging; when using water as the medium, excessive bleeding during surgery can obscure the field of view, thereby increasing the risk of dural and nerve root damage \u003csup\u003e[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eThe Delta large channel is a single-hole endoscope, Compared with UBE, the single-hole endoscope has less muscle dissection and can flexibly adjust the direction of the endoscope according to the direction of the nucleus pulposus protrusion to reach the protrusion site\u003csup\u003e[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]\u003c/sup\u003e; ​​compared with the transforaminal endoscope, The diameter of the endoscope reaches 10 mm, the field of view under the endoscope is wider, and it is highly maneuverable. It can minimize iatrogenic damage, and the precise removal and decompression of prominent nucleus pulposus tissue is more thorough, improving work efficiency. And the tubular channel is used for orderly tissue expansion, allowing precise access to the surgical area for surgery, preserving the entire posterior paravertebral musculature, and minimizing trauma \u003csup\u003e[\u003cspan additionalcitationids=\"CR15\" citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]\u003c/sup\u003e. Furthermore, the presence of a large operational space, coupled with minimal damage to the muscle attachment points and joint capsule of the surgical segment, significantly reduces the risk of postoperative low back pain\u003csup\u003e[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003ePrevious studies have suggested that both DLED and UBED are effective minimally invasive surgical techniques for treating lumbar disc herniation and can also be used to manage more complex cases of lumbar spinal stenosis. Compared to other minimally invasive techniques utilizing water- or air-based media, these two approaches offer advantages such as improved surgical efficiency and a clearer operative field. However, to date, no comparative studies have been conducted between these two techniques. This study aims to evaluate and compare the efficacy and safety of DLED and UBED in the treatment of single-level lumbar disc herniation.\u003c/p\u003e \u003cp\u003eCompared with the DLED group in this study, the operation duration of the UBED group was significantly longer. We believe that there are two main reasons: 1. The learning curve for UBE technology remains steep, with creating an operating space and identifying specific anatomical landmarks as the main difficulties.; 2. The intraoperative bleeding hemostasis operation takes a long time, and the intraoperative bleeding volume is larger than that of the DLED group\u003csup\u003e[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]\u003c/sup\u003e. Although the changes in HB and HCT after surgery were not obvious, the loss of Hb and Hct proved it from the side. Previous studies have shown that there is a relationship between CK levels and the pressure exerted on paravertebral muscles\u003csup\u003e[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]\u003c/sup\u003e. Serum CK concentration can be used as an effective indicator of muscle damage, and the increase in its level is closely related to the invasiveness of surgery \u003csup\u003e[\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]\u003c/sup\u003e. In our study, the CK levels of both groups increased significantly on the first day after surgery, especially in the UBED group. We believe that the DLED group uses the stepwise expansion channel muscle splitting technology to directly reach the target location, thereby maintaining the integrity of the paravertebral muscles and causing less muscle damage\u003csup\u003e[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eThe study comparing the PELD group with the UBE group found that the HBL of the PELD group was significantly lower than that of the UBE group, mainly because in the UBE technique, partial laminectomy may cause cancellous bone bleeding\u003csup\u003e[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]\u003c/sup\u003e. In our study, DELTA large-channel endoscope was used, and part of the lower edge of the lamina and the inner edge of the inferior articular process also needed to be removed during the operation, If excessive bleeding occurs from the bony surface, bone wax can be utilized to attain hemostasis\u003csup\u003e[\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]\u003c/sup\u003e. The results of the study found that the hidden blood loss in the UBED group was higher than that in the DLED group, We believe that the additional channels used in UBE technology will cause greater damage to soft tissues, increase perioperative bleeding, and then lead to an increase in HBL\u003csup\u003e[\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]\u003c/sup\u003e. In addition, prolonged UBE surgery will increase the possibility of interstitial leakage, making it easier for blood to spread into the interstitial space, thereby further aggravating the degree of HBL\u003csup\u003e[\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]\u003c/sup\u003e. In addition, the calculation method of intraoperative blood loss mainly includes estimating based on the difference between the amount of fluid aspirated and the amount of saline flushed, and the amount of blood absorbed by the gauze also needs to be considered. Although this method is widely used in most settings, it may itself introduce a degree of bias. Therefore, the actual hidden blood loss (HBL) is often underestimated due to the bias introduced by these estimation methods.\u003c/p\u003e \u003cp\u003eOur results indicate that the VAS and ODI scores at each observation point following surgery in both groups were significantly lower than those recorded prior to surgery. Furthermore, these indicators showed a progressive improvement during the follow-up period, leading to high levels of patient satisfaction and the absence of notable complications. These findings suggest that both minimally invasive surgical techniques are effective in treating lumbar disc herniation with regard to safety and efficacy.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eIn summary, UBE and Delta large-channel endoscopic surgery show considerable efficacy and safety in reducing pain and improving function in patients with LDH. However, compared with UBED, DLED has certain advantages in terms of operation time, blood loss, and soft tissue damage. This study has several limitations. First, this study was a retrospective study with a relatively small sample size and lack of randomized design, so some potential biases may not be completely ruled out. In addition, given the short follow-up time of this study, further mid- and long-term follow-up observations are needed to obtain more comprehensive and reliable data.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eLDH\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eLumbar disc herniation\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eDLED\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eDelta large-channel endoscopic discectomy\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eUBED\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eUnilateral biportal endoscopic discectomy\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eVAS\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eVisual Analog Scale\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eODI\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eOswestry Disability Index\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eVAS\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eVisual Analog Scale\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe authors would like to thank all the reviewers and editors who participated in the review.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll data generated or analyzed during this study are included in this published article and are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical trial number\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics declarations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthics approval and consent to participate\u003c/p\u003e\n\u003cp\u003eThis material has not been published and is not under consideration elsewhere. This study is approved by the Medical Ethics Committee of the Nanjing Jinling Hospita. All authors have confirmed that all methods were performed in accordance with the relevant guidelines and regulations. This study obtained the informed consent of all patients or their legal guardians, and all patients or their legal guardians agreed to participate in this study. This study adhered to the Declaration of Helsinki.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot Applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors' contributions\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eGuodong Guo\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eand Yang Qiu\u003c/strong\u003e: Conceptualization, Methodology, Validation, Formal analysis, Investigation, Data curation, Writing – original draft, Writing – review \u0026amp; editing, Visualization. \u003cstrong\u003eSuohua Pan\u003c/strong\u003e: Validation, Formal analysis, Investigation. \u003cstrong\u003eDaokuan Gao\u003c/strong\u003e: Data curation,Methodology, Writing – review \u0026amp; editing.\u003cstrong\u003eHuijuan Ma and Gang Liu\u003c/strong\u003e: Conceptualization, Writing – review \u0026amp; editing, Supervision, Project administration, Funding acquisition.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eHuijuan Ma and Gang Liu\u003c/strong\u003e contributed equally to this work are joint corresponding authors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was supported by the 2023 Life and Health Technology Special Project of Nanjing [grant number 202305018].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eYoon WW, Koch J. 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Translaminar lumbar epidural endoscopy: anatomy, technique, and indications. \u003cem\u003eArthroscopy\u003c/em\u003e. 1996;12(3):330-334. doi:10.1016/s0749-8063(96)90069-9\u003c/li\u003e\n \u003cli\u003eHe K, et al. The Implications of Paraspinal Muscle Atrophy in Low Back Pain, Thoracolumbar Pathology, and Clinical Outcomes After Spine Surgery: A Review of the Literature. \u003cem\u003eGlobal Spine J\u003c/em\u003e. 2020;10(5):657-666. doi:10.1177/2192568219879087\u003c/li\u003e\n \u003cli\u003eZhang JJ, et al.Clinical Efficacy Study of the Quadrant Channel and Delta Large Channel Technique in the Treatment of Lumbar Degenerative Diseases. \u003cem\u003eInt J Gen Med\u003c/em\u003e. 2021;14:2437-2447. Published 2021 Jun 10. doi:10.2147/IJGM.S309272\u003c/li\u003e\n \u003cli\u003eIto F, et al. Step-by-Step Sublaminar Approach With a Newly-Designed Spinal Endoscope for Unilateral-Approach Bilateral Decompression in Spinal Stenosis. \u003cem\u003eNeurospine\u003c/em\u003e. 2019;16(1):41-51. doi:10.14245/ns.1836320.160\u003c/li\u003e\n \u003cli\u003eWang R, et al. Microscopic decompressive laminectomy versus percutaneous endoscopic decompressive laminectomy in patients with lumbar spinal stenosis: protocol for a systematic review and meta-analysis. \u003cem\u003eBMJ Open\u003c/em\u003e. 2020;10(9):e037096. Published 2020 Sep 9. doi:10.1136/bmjopen-2020-037096\u003c/li\u003e\n \u003cli\u003eYang F, et al. Clinical Comparison of Full-Endoscopic and Microscopic Unilateral Laminotomy for Bilateral Decompression in the Treatment of Elderly Lumbar Spinal stenosis: A Retrospective Study with 12-Month Follow-Up. \u003cem\u003eJ Pain Res\u003c/em\u003e. 2020;13:1377-1384. Published 2020 Jun 11. doi:10.2147/JPR.S254275\u003c/li\u003e\n \u003cli\u003eYin J, et al.Comparative Study Between Unilateral Biportal Endoscopic Discectomy and Percutaneous Interlaminar Endoscopic Discectomy for the Treatment of L5/S1 Disc Herniation. \u003cem\u003eWorld Neurosurg\u003c/em\u003e. 2025;194:123526. doi:10.1016/j.wneu.2024.11.109\u003c/li\u003e\n \u003cli\u003eZhang J, et al. Comparison of the short-term effects of lumbar endoscopic and microscopic tubular unilateral laminotomy with bilateral decompression in the treatment of elderly patients with lumbar spinal stenosis. \u003cem\u003eEur J Med Res\u003c/em\u003e. 2022;27(1):222. Published 2022 Oct 29. doi:10.1186/s40001-022-00847-0\u003c/li\u003e\n \u003cli\u003eGuo S, et al. Risk factors for hidden blood loss in unilateral biportal endoscopic lumbar spine surgery. \u003cem\u003eFront Surg\u003c/em\u003e. 2022;9:966197. Published 2022 Aug 15. doi:10.3389/fsurg.2022.966197\u003c/li\u003e\n \u003cli\u003eWang H, et al. Analysis of risk factors for perioperative hidden blood loss in unilateral biportal endoscopic spine surgery: a retrospective multicenter study. \u003cem\u003eJ Orthop Surg Res\u003c/em\u003e. 2021;16(1):559. Published 2021 Sep 15. doi:10.1186/s13018-021-02698-7\u003c/li\u003e\n \u003cli\u003eKumbhare D, Parkinson W, Dunlop B. Validity of serum creatine kinase as a measure of muscle injury produced by lumbar surgery. \u003cem\u003eJ Spinal Disord Tech\u003c/em\u003e. 2008;21(1):49-54. doi:10.1097/BSD.0b013e31805777fb\u003c/li\u003e\n \u003cli\u003eZhou S, et al. Comparison of surgical invasiveness and hidden blood loss between unilateral double portal endoscopic lumbar disc extraction and percutaneous endoscopic interlaminar discectomy for lumbar spinal stenosis. \u003cem\u003eJ Orthop Surg Res\u003c/em\u003e. 2024;19(1):778. Published 2024 Nov 21. doi:10.1186/s13018-024-05274-x\u003c/li\u003e\n \u003cli\u003eChoi KC, et al. Comparison of Surgical Invasiveness Between Microdiscectomy and 3 Different Endoscopic Discectomy Techniques for Lumbar Disc Herniation. \u003cem\u003eWorld Neurosurg\u003c/em\u003e. 2018;116:e750-e758. doi:10.1016/j.wneu.2018.05.085\u003c/li\u003e\n \u003cli\u003eJiang HW, et al. Unilateral biportal endoscopic discectomy versus percutaneous endoscopic lumbar discectomy in the treatment of lumbar disc herniation: a retrospective study. \u003cem\u003eJ Orthop Surg Res\u003c/em\u003e. 2022;17(1):30. Published 2022 Jan 15. doi:10.1186/s13018-022-02929-5\u003c/li\u003e\n \u003cli\u003eLiu JW, et al. Hidden blood loss in percutaneous endoscopic lumbar discectomy via the posterolateral approach. \u003cem\u003eJt Dis Relat Surg\u003c/em\u003e. 2025;36(1):56-64. doi:10.52312/jdrs.2025.2065\u003c/li\u003e\n \u003cli\u003eAo S, et al. Comparison of Preliminary clinical outcomes between percutaneous endoscopic and minimally invasive transforaminal lumbar interbody fusion for lumbar degenerative diseases in a tertiary hospital: Is percutaneous endoscopic procedure superior to MIS-TLIF? A prospective cohort study. \u003cem\u003eInt J Surg\u003c/em\u003e. 2020;76:136-143. doi:10.1016/j.ijsu.2020.02.043\u003c/li\u003e\n \u003cli\u003eYang Y, Peng YX. Hidden blood loss and its risk factors in percutaneous vertebroplasty surgery for osteoporotic vertebral compression fractures. \u003cem\u003eArch Orthop Trauma Surg\u003c/em\u003e. 2023;143(9):5575-5581. doi:10.1007/s00402-023-04873-3\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"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":"bmc-musculoskeletal-disorders","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmsd","sideBox":"Learn more about [BMC Musculoskeletal Disorders](http://bmcmusculoskeletdisord.biomedcentral.com/)","snPcode":"","submissionUrl":"https://author-welcome.nature.com/12891","title":"BMC Musculoskeletal Disorders","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Delta large-channel endoscopic discectomy, Unilateral biportal endoscopic discectomy, lumbar disc herniation, clinical efficacy and safety","lastPublishedDoi":"10.21203/rs.3.rs-6512924/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6512924/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eOBJECTIVE \u003c/strong\u003eTo compare the clinical efficacy and safety of two posterior minimally invasive surgeries using percutaneous interlaminar approach: Delta large-channel endoscopic discectomy(DLED) versus Unilateral biportal endoscopic discectomy(UBED) in the treatment of lumbar disc herniation(LDH).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMETHODS \u003c/strong\u003eA retrospective analysis was conducted on 74 LDH patients treated with DLED(39 cases) and UBED(35 cases) from January 2023 to January 2024. Observe the operation time, number of fluoroscopy, intraoperative blood loss(IBL), total blood loss(TBL), hidden blood loss(HBL), and postoperative hemoglobin(HB), hematocrit(HCT), and creatine kinase (CK)levels. At the same time, the clinical efficacy was evaluated using the pain visual analog scale(VAS), Oswestry Disability Index(ODI) and modified Macnab assessment criteria.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResult \u003c/strong\u003eCompared with DLED group, UBED group was associated with longer operation time, \u0026nbsp;more Hb loss, more Hct loss, and higher CK level (\u003cem\u003eP\u003c/em\u003e \u0026lt; 0.05) . Additionally, IBL, TBL, and HBL in the DLED group were less than those in the UBED group (\u003cem\u003eP\u003c/em\u003e \u0026lt; 0.05). Postoperative VAS scores and ODI scores showed significant decreases in both groups compared to preoperative scores (\u003cem\u003eP\u003c/em\u003e\u0026lt; 0.05). However, there was no significant difference in VAS and ODI scores between the two groups at 1 day 、3 months、 6 months postoperatively (\u003cem\u003eP\u003c/em\u003e \u0026gt; 0.05). Additionally, no notable differences were observed in the modified MacNab criteria.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCONCLUSION\u003c/strong\u003e UBED and DLED are two minimally invasive techniques that have demonstrated significant effectiveness and safety in the treatment of LDH. However, the DLED group exhibits certain advantages over the UBED group, particularly regarding operation time, blood loss, and soft tissue damage.\u003c/p\u003e","manuscriptTitle":"Delta large-channel endoscopic discectomy versus Unilateral biportal endoscopic discectomy in the treatment of lumbar disc herniation: A Retrospective Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-05-26 01:56:44","doi":"10.21203/rs.3.rs-6512924/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewerAgreed","content":"22083082749553299402157123809284415934","date":"2025-05-30T17:17:59+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-05-21T13:12:16+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-04-29T07:33:04+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-04-28T15:21:37+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-04-28T15:16:57+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Musculoskeletal Disorders","date":"2025-04-23T12:55:47+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-musculoskeletal-disorders","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmsd","sideBox":"Learn more about [BMC Musculoskeletal Disorders](http://bmcmusculoskeletdisord.biomedcentral.com/)","snPcode":"","submissionUrl":"https://author-welcome.nature.com/12891","title":"BMC Musculoskeletal Disorders","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"3ae77625-b77b-42e4-95ad-52ef736c9950","owner":[],"postedDate":"May 26th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-05-26T01:56:44+00:00","versionOfRecord":[],"versionCreatedAt":"2025-05-26 01:56:44","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6512924","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6512924","identity":"rs-6512924","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}