The Comparison of unilateral biportal endoscopic (UBE) and Percutaneous Endoscopic Lumbar Discectomy(PELD) in the Treatment of single-level lumbar disc herniation

The Comparison of unilateral biportal endoscopic (UBE) and Percutaneous Endoscopic Lumbar Discectomy(PELD) in the Treatment of single-level lumbar disc herniation | 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 Article The Comparison of unilateral biportal endoscopic (UBE) and Percutaneous Endoscopic Lumbar Discectomy(PELD) in the Treatment of single-level lumbar disc herniation Xuyuan Xie, Wei Song, Yulu Lu, Yueying Wang, Xuzhou Liu, Junyu Xu, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6149697/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background : The objective of this study was to compare the clinical efficacy of unilateral dual-channel spinal endoscopy (UBE) and percutaneous foraminoscopy (PELD) in the treatment of single-level disc herniation. Patients and Methods: This study recruited patients with lumbar disc herniation who were hospitalized in the spinal surgery Department of Zhaoqing First People's Hospital from January 2021 to December 2023. A total of 51 patients underwent minimally invasive spinal endoscopy, including 23 in the UBE group and 28 in the PELD group.All patients were followed for at least 1 year. Demographic characteristics, Pfirrmann grade, intraoperative and postoperative data, complications and prognostic indicators of intervertebral disc degeneration were analyzed in the two groups. Japanese Orthopaedic Association scores (JOA score), Oswestry disability index (ODI index), visual analog scale (VAS score), and modified macnab criteria were used to evaluate all clinical outcomes. Results: There were no significant differences in demographic characteristics between the two groups, including gender, age, anesthesia ASA score, responsible segment composition, follow-up time and Pfirrmann grade of disc degeneration. PELD was superior to UBE in terms of operation and anesthesia time, blood loss and incision length (p < 0.05), suggesting that PELD is more minimally invasive. However, the intraoperative fluoroscopy of UBE is significantly less than that of PELD (p 0.05), but the scores of JOA, VAS, ODI and modified Macnab after surgery in the two groups were improved compared with those before surgery, with significant statistical significance (p < 0.05). Conclusion: UBE and PELD are safe and effective in the treatment of single segment lumbar disc herniation. UBE has a wider intraoperative field of view and more flexible operation. PELD surgery is less invasive, and perioperative recovery is faster, but it is more difficult to operate. Biological sciences/Neuroscience/Spine regulation and structure/Spine structure Health sciences/Neurology/Neurological disorders lumbar disc herniation unilateral biportal endoscopic discectomy percutaneous foramicroscopy Minimally invasive surgery invasive surgery Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Figure 7 1. Introduction A lumbar disc herniation occurs when the compressors (one or more of the cartilaginal endplate, nucleus pulposus, or annulus fibrosus) are locally displaced beyond the edge of the disc space, but may not necessarily present clinically [ 1 ]. When the lumbar disc herniation appears lower limb paresthesia, muscle strength decline, dysfunction is called lumbar disc herniation [ 2 ]. The pathogenesis of radiculopathy associated with lumbar disc herniation is both biochemical and mechanical, due to the inflammatory response generated by the contact between the protruding nucleus pulposus and nerve roots, which together lead to radiculopathic pain [ 1 ]. For lumbar disc with the natural course of nerve root disease, NASS(the north American spine society)provides evidence-based advice that the majority of patients after conservative treatment degeneration outstanding intervertebral disc can reduce over time, degradation, changes in plants could also improve independent of treatment [ 3 ]. However, conservative treatment is not effective for every patient, and timely surgical treatment is required when the symptoms of the patient have not been relieved for more than 3 to 6 months after conservative treatment, or when the symptoms of the cauda equina nerve such as lower limb hypoesthesia, decreased muscle strength, and urinary and bowel dysfunction are combined [ 4 ]. Surgery for lumbar disc herniation was first proposed by Walter [ 5 ] in 1929 and Mixter [ 6 ] in 1932. In 1938, Dr. GraftonJ.Love modified the procedure, known as the LOVE technique, and the standard procedure is still used today [ 7 , 8 ]. However, the disadvantages of open surgery, such as long incision, more bleeding, and large bone tissue removal area, make patients recover slowly after surgery and stay in hospital for a long time, so orthopedic doctors have been thinking about how to avoid the above situations.The emergence of minimally invasive techniques has greatly avoided most of the disadvantages of open surgery. Yasargil [ 9 ] used a surgical microscope for the first time in 1977 to remove disc herniation [ 10 ], making minimally invasive disc resection technology gradually become the "gold standard" for surgical treatment of lumbar disc herniation [ 11 ]. The advantage of minimally invasive techniques is the ability to treat various types of disc herniations through short approaches to the skin, fascia, and muscles, as well as limited laminectomy or joint removal [ 10 ]. With the continuous development of spinal endoscopy technology and the improvement of instruments, its application has been increasingly favored by orthopedic surgeons and patients [ 12 ]. Percutaneous endoscopic lumbar discectomy (PELD) and unilateral biportal endoscopy(UBE) is the two most widely used spinal endoscopic techniques. PELD includes two surgical approaches: transforaminal and translaminal. The transforaminal approach is divided into YESS technique and TESSYS technique. YESS technique is an indirect decompression technique, which has unsatisfactory effects on herniated intervertebral disc, lateral recess stenosis, and foraminal stenosis [ 13 ]. In view of the shortcomings of YESS technology, Hoogland [ 14 ] improved it in 2003 and developed TESSYS technology, which is to directly decompress lumbar disc herniation by forming the upper articular process with a circular saw under the mirror.In recent years, unilateral dual-channel technique (UBE) has been favored by spinal surgeons due to its smooth learning curve, wide endoscopic field of view and more flexible operation mode, especially in the field of spinal canal decompression, which is more efficient [ 15 – 18 ]. The operation mode of UBE is similar to that of arthroscopy, with two channels, namely the visual channel for endoscope placement and the working channel for instrument operation [ 19 ]. Due to the presence of these two channels, the spine surgeon can easily complete the removal of the disc and the suture of the annulus fibrosus in the working channel [ 20 ]. Previous studies have shown that lumbar disc herniation can be operated on by the above two endoscopic techniques, however, there are few reports on the comparison of clinical efficacy of the two techniques. Therefore, in order to explore the differences between the two techniques, this paper intends to compare the technical differences between the two by analyzing the postoperative clinical efficacy of patients in the spine surgery department of Zhaoqing First People's Hospital. 2. Patients and methods This study recruited patients with single-level lumbar disc herniation who were hospitalized in the spinal surgery Department of Zhaoqing First People's Hospital from January 2021 to December 2023. All patients were treated with minimally invasive endoscopic spinal surgery. The inclusion criteria of the study were: ① Consistent with the "international expert consensus on rehabilitation treatment of lumbar disc herniation", confirmed by CT and magnetic resonance imaging; ② 30–70 years old; ③ Patients with low back pain or radioactive leg pain, with clear indications for surgery; ④ General health condition can be able to withstand surgical anesthesia; ⑤ Complete clinical data and complete follow-up data more than 12 months after surgery. The exclusion criteria are: ① the symptoms are not clear or suspicious; ② History of spinal surgery; ③ Combined with spondylolisthesis, fracture or dislocation, expansion or destruction of vertebral structure; ④ Accompanied by a history of mental illness; ⑤ Recurrent lumbar disc herniation; ⑥Patients with severe infection or tumor or with organic diseases such as heart, liver and kidney, who cannot tolerate surgery; ⑦ Patients with incomplete clinical and follow-up data; ⑧ Loss of visit. After review, a total of 51 patients met the above inclusion criteria and were randomly divided into two groups, one of which underwent UBE surgery; The other group underwent PELD surgery, both performed by the same group of experienced physicians. The institutional review committee of Zhaoqing First People's Hospital approved the study. All patients signed informed consent before operation. This study was conducted in accordance with the ethical standards set out in the Declaration of Helsinki. After inclusion exclusion criteria, a total of 51 patients were enrolled in the study, including 33 men and 18 women. They ranged in age from 30 to 70, with an average age of 48. After admission, all patients underwent lumbar MRI, lumbar X-ray anterior-lateral radiography, and lumbar CT examination. JOA, VAS, ODI, and modified MacNab scores were performed by an independent surgeon in all patients after surgery. MRI was performed on all patients after operation to evaluate the curative effect. 2.1. Sugical techniques All surgeries were performed by the same treatment group of surgeons with more than 15 years of surgical experience. UBE group: Unilateral double-channel surgery (UBE) is usually performed under tracheal intubation and general anesthesia. The patient is in a prone position with the abdomen overhanging at the lumbar bridge. With the aid of the C-arm machine, the responsible segment was positioned by fluoroscope. The spinous process line was initially positioned as the posterior median line according to the body surface marks, and a horizontal line perpendicular to the median line was made parallel to the diseased intervertebral space. A marking point was made at the point 1.5cm above the baseline and 1.5cm below the baseline. A longitudinal incision about 1cm long was made with the above two marks as the center (Fig. 1a). Use the sleeve to expand step by step to establish the observation and operation channels (Fig. 1c, d). If the lesion is on the left side, the cephalic incision is used as the viewing channel and the caudal incision is used as the operating channel (Fig. 1b). Radiofrequency ablation electrodes were used to peel the soft tissue on the surface of the laminae under an endoscopic view to expose structures such as the lower margin of the upper laminae, the upper margin of the lower laminae, the ligamenta flavoides, and the medial facet joints. The lower edge of the upper endplate, the upper edge of the lower endplate, and the inner wall of the facet joint were thinned with an electric grinding drill to reveal the edges and stops of the ligamentum flavoides (Fig. 2a). The laminae were then partially removed with laminae lumbar forceps up to the insertion point of the ligamentum flavum. The ligamentum flavum was partially removed to expose the underlying dural sac and nerve root (Fig. 2b). A special nerve root retractor was used to pull the dural sac and nerve root apart from the exposed annulus. The annulus was cut open with a sharp knife to expose the protruding nucleus pulposus. The nucleus pulposus was then completely removed from the intervertebral disc using a nucleus pulposus forceps (Fig. 2c). Under the microscope, the dural sac and nerve root were found to be in normal shape, and the dural sac returned to pulsation, and there was no obvious tension in the nerve root after the nerve root stripper exploration, indicating that the nerve root had been decompressed. Figure 2d demonstrates the nucleus pulposus tissue retrieved through the unilateral biportal endoscopic (UBE) technique. Hemostasis was performed in the operating field, irrigation was closed, irrigation fluid was extruded, and the incision was closed. Walk with waist protection after operation.Preoperative and postoperative MRI examinations were performed to evaluate and compare therapeutic efficacy (Fig. 3). PELD group: Patients undergoing unilateral, single-channel (PELD) surgery may be performed under either local infiltration anesthesia or tracheal intubation under general anesthesia. The patient is in a prone position with the abdomen overhanging at the lumbar bridge and the knees and hips in flexion. According to the body surface signs, the spine process line was initially positioned as the posterior median line, and according to the symptoms of the lower extremities of the patient, the left or right approach was determined to make an intersection point between the horizontal line of the diseased vertebral space and the posterior median line. The puncture point of the foraminal approach is at the level of L2/3 and L3/4, generally 8-10cm next to the intersection point, and L4/5 is about 12cm [21]. For the L5/S1 segment, the interlaminar approach is generally chosen due to the occlusion of the iliac crest (Fig. 4a). Taking L5/S1 as an example, the puncture point was marked, and the puncture needle and sleeve were inserted at the fixation point under C-arm perspective. The sleeve was located at the junction between the middle vertical line of the interlaminar space on one side of the midline of the spinous process and the upper and lower laminae on the anteriorview (Fig. 4c), and the distal end of the sleeve was located on the surface of the laminae on the lateral view (Fig. 4d). After the position of the working channel was confirmed, foramicroscope was inserted (Fig. 4b), and radio-frequency knife head was used to stop bleeding and remove the surrounding soft tissue (Fig. 5a). The L5/S1 interlaminar ligamentum flandum was exposed (Fig. 5b), and part of the ligamentum flandum was removed with blue forceps, the dural sac and nerve root were exposed, and the nucleus pulposus tissue protruded within the intervertebral disc was removed with nucleus pulposus forceps (Fig. 5c). The residual nucleus pulposus debris was explored and removed to fully decompress the compressed nerve root (Fig. 5d). After endoscopic cleaning of the surrounding nerve roots, it was confirmed that the dural and nerve roots were fully loosened without active bleeding, and the foraminal mirror and sleeve were withdrawn and the incision was sutured. Figure 5e demonstrates the nucleus pulposus tissue retrieved through the percutaneous endoscopic lumbar discectomy (PELD) technique. On the day after surgery, straight leg elevation training can be performed on the bed, and on the first day after surgery, patients can walk under the protection of the waist.Preoperative and postoperative MRI examinations were performed to evaluate and compare therapeutic efficacy (Fig. 6). 2.2. Follow-up protocol Perioperative management: Antibiotics were used once during operation and once after operation. Walk with girth protection on day 1–3 after surgery. Brake for 4–6 weeks, and heavy physical labor is prohibited within 3–6 months. X-ray and MRI were re-examined after operation to understand the operation situation. Outcome measures: Preoperative observation contents: ① Age; ② Gender; ③BMI; ④ ASA; ⑤ Responsibility section; ⑥ Follow-up time; ⑦ Duration of disease; Preoperative VAS, ODI and JOA scores. Intraoperative observation: ① Blood loss; ② Operation time ③ Anesthesia time; ④Intraoperative fluoroscopy times; ⑤Length of surgical incision; Postoperative observation contents: ① VAS scores 1 week and 1 and 12 months after surgery;② ODI scores 1 week and 1 and 12 months after surgery; ③ JOA score 1 week and 1 and 12 months after surgery; ④ Postoperative hospital stay; ⑤ Improved Macnab score after operation; ⑥ Time to walk. 2.3. Statistical analysis Statistics and analysis of all data in this study were performed using SPSS23.0. Categorical variables are expressed as frequency and percentage, while continuous variables are expressed as mean ± SD/ mean ± SD (median). For continuous variables showing a normal distribution, students' t test is used to compare the two groups. For parameters that do not display normal distribution, Mann-WhitneyU test is used. For categorical variables, Pearson chi-square test and Fisher exact chi-square test are used. In all statistical analyses, a value of P < 0.05 is considered to be significantly different. 3. Results 3.1. Preoperative information of patients A comparison of the demographic statistics and typing characteristics of the two groups is shown in Table 1 . A total of 51 eligible patients were enrolled from January 2021 to December 2023. Of these, 23 were in the UBE group and 28 were in the PELD group. In the UBE group, there were 112 L5/S112 patients and 10 non-L5 /S1 patients. The mean age of the patients was 51 years old, BMI was 23.9, and the ASA evaluation score of anesthesia was 19 patients (1–2 patients) and 4 patients (3–4 patients). The mean follow-up time was 13.7 months. In the PELD group, there were 10 patients with L5/S1 and 18 patients with non-L5 /S1. The average age of patients was 46.57 years old, BMI was 24.97, and the ASA evaluation score of anesthesia was 1–2 points for 24 patients, and 3–4 points for 4 patients. The average follow-up time was 13.7 months. There were no significant differences between the two groups in gender, age, anesthesia ASA score, responsible segment composition, Pfirrmann grade of disc degeneration, and follow-up time. Table 1 General patient condition data Total patient (n = 51) UBE (n = 23) PELD (n = 28) P value Gender (%) 0.268a Male 33 (64.7) 13 (56.5) 20 (71.4) Female 18 (35.3) 10 (43.5) 8 (28.6) Age(years), mean ± SD 48.86 ± 12.57 51.65 ± 14.05 46.57 ± 10.95 0.153d BMI, men ± SD 23.49 ± 4.09 23.90 ± 3.62 24.97 ± 4.44 0.364c ASA (%) 0.762b 1–2 43 (84.3) 19 (82.6) 24 (85.7) 3–4 8 (15.7) 4 (17.4) 4 (14.3) Responsible levels (%) 0.238a L5/S1 22 (43.1) 12 (52.2) 10 (35.7) Others 29 (56.9) 11 (47.8) 18 (64.3) Pfirrmann Classification (%) 0.741a III 24 (47.1) 8 (34.8) 11 (39.3) IV 27 (52.9) 15 (65.2) 17 (60.7) Follow up time 13.73 ± 1.65 13.74 ± 1.84 13.71 ± 1.51 0.897c a: Pearson Chi-Square test. b: Fisher exact test. c: Mann-Whitney U test. d: Student t test. 3.2. Intraoperative statistical data The comparison of data between the two groups is shown in Table 2 . During each operation, the operative time, anesthesia method and time, intraoperative fluoroscopy times, blood loss, incision length, dural and nerve root injury were counted. All anesthesia methods of UBE were general anesthesia, while 20 cases of PELD were local anesthesia and 8 cases were general anesthesia. The operative time of UBE was longer than that of PELD, which was statistically significant. The duration of anesthesia of UBE was also longer than PELD, which was statistically significant. Both blood loss and incision length were longer in UBE than in PELD. However, the fluoroscopy frequency of UBE was less than that of PELD, which was statistically significant. During the operation, there were 2 cases of dural sac injury in UBE and 1 case of nerve root pulling injury in PELD. Table 2 Intraoperative situation data Total patient (n = 51) UBE (n = 23) PELD (n = 28) P value Anesthesia < 0.01b General 23 (45.1) 23 (100) 8 (28.6) Local infiltration 28(54.9) 0 (0.00) 20 (71.4) Procedure time 140.98 ± 50.03 165.00 ± 61.22 121.25 ± 26.20 0.012c Anesthesia time 168.47 ± 58.40 208.13 ± 58.13 135.89 ± 33.50 < 0.01c Blood loss 12.53 ± 7.70 16.96 ± 9.26 8.89 ± 3.06 < 0.01c Intraoperative fluoroscopy times 8.67 ± 2.90 6.52 ± 2.11 10.43 ± 2.20 <0.01c Incisive length 15.67 ± 6.83 22.61 ± 2.92 9.96 ± 2.15 < 0.01c Dural sac tear 2 2 0 Nerve injury 1 0 1 a: Pearson Chi-Square test. b: Fisher exact test. c: Mann-whitney U test. d: Student t test. 3.3. Postoperative and follow-up statistics We analyzed the scores of patients after UBE and PELD surgery (Table 3 and Fig. 7 ). Compared with before treatment, VAS, JOA score and ODI index of 2 groups were significantly improved 1 week after surgery, and the difference was statistically significant. There was no significant difference in VAS, JOA score and ODI index before surgery, 1 month and 1 year after surgery. Table 3 Postoperative Follow up Data Total patient (n = 51) UBE (n = 23) PELD (n = 28) P value Post-operative hospital’s day (days), mean ± SD (median) 5.88 ± 1.99 6.78 ± 2.13 5.14 ± 1.56 0.020c DVT 0 0 0 superficial wound infections 0 0 0 VAS Score, mean ± SD (median) Pre-operative 7.59 ± 1.02 7.43 ± 1.04 7.46 ± 1.45 0.576c Post-operative 1.43 ± 0.50 1.43 ± 0.51 1.43 ± 0.50 0.965c JOA Score, mean ± SD (median) Pre-operative 11.49 ± 1.91 12.13 ± 1.60 10.96 ± 2.00 0.431c Post-operative 24.86 ± 1.37 24.96 ± 1.11 24.79 ± 1.57 0.735c ODI Score, mean ± SD (median) Pre-operative 59.16 ± 2.86 58.26 ± 2.77 59.89 ± 2.77 0.037c Post-operative 10.14 ± 1.67 9.83 ± 1.70 10.39 ± 1.64 0.211c Macnab score 0.809b Excellent and good 46 (90.2) 21 (91.3) 25 (89.3) Fair and poor 5 (9.8) 2 (8.7) 3 (9.7) Postoperative walking time on the ground (d) 1.94 ± 1.01 2.83 ± 0.78 1.21 ± 0.42 < 0.01c a: Pearson Chi-Square test. b: Fisher exact test. c: Mann-whitney U test. d: Student t test. At one year after surgery, the overall curative effect rate was 91.3% in the UBE group and 89.3% in the PELD group according to the MacNab standard, and there was no statistically significant difference between the two groups. 4. Discussion With the development of minimally invasive spinal surgery, spinal endoscopy has gradually replaced the traditional open surgery and become the main surgical method for LDH. Due to the features of minimally invasive incision, small damage to muscle and bone, and short hospital stay, spinal endoscopy greatly alleviates postoperative low back pain and spinal instability of patients, so it is widely accepted and applied in clinical practice by spinal surgeons [ 22 ]. UBE and PELD are the most widely used minimally invasive techniques in the field of spinal minimally invasive techniques. PELD is a single-channel spinal endoscopy technique that combines the viewing, operating, and irrigating channels into one channel and is operated with a series of specialized instruments. PELD includes the lateral foraminal approach and the dorsal interlaminar approach, and the sacrospinous muscle is not dissected during the operation, which avoids chronic low back pain caused by denerinnervation during the operation, and part of PELD can be performed under local anesthesia to facilitate communication with patients, thus reducing the risk of nerve injury. UBE is a dual-channel spinal endoscopy technique. The difference between this technique and PELD is that UBE is composed of two channels, including observation channel and operation channel, with dedicated instruments for intraspinal decompression or removal of the nucleus pulposus. Because the biggest feature of UBE is the separation of the observation channel and the operating channel, it has a wider surgical field of view and a more flexible operating space. Previous relevant literature reports also show that UBE has a smoother learning curve [ 23 ] and has more obvious advantages in promotion. In this study, there were no significant differences in preoperative gender, age, anesthesia ASA score, responsible segment composition, disc classification, and follow-up time between the UBE and PELD groups. In comparison of intraoperative conditions, all patients in UBE group underwent general anesthesia, while PELD had two anesthesia methods: general anesthesia or local anesthesia. The reason was that during UBE surgery, special nerve root retractor was needed to stretch the compressed nerve root to expose the protruded nucleus pulposus. Patients could not tolerate pain during this process, so all patients in UBE group underwent general anesthesia. The main difference between the two anesthesia methods in PELD group was the difference at the responsible level. In L5/S1 segment, the surgical approach was interlaminar approach, so general anesthesia was used, while in non-L5/S1 segment, foraminal approach was used, so local anesthesia was used, so as to facilitate communication with patients and avoid nerve root damage. In addition, the duration of operation and anesthesia in the UBE group was higher than that in the PELD group, which had different results from previous literature reports [ 24 ]. The reason is that PELD surgery was carried out earlier than UBE surgery in our hospital, so PELD technology has crossed the learning curve and reached a stable stage, while UBE technology is in the process of crossing the learning curve, so its proficiency is not good. With the increase of surgical experience, it may be possible to significantly reduce the length of surgery and anesthesia. However, the number of fluoroscopy in UBE group is significantly lower than that in PELD group, because UBE technology adopts interlaminar approach, convenient positioning, and does not need to adjust the direction and Angle of the puncture needle repeatedly, which can reduce the amount of radiation received by the operator and the patient. UBE needs to strip more soft tissue during surgery, so it needs to perform multiple hemostatic operations, which also makes UBE bleed more than PELD. In addition, because the dual channel nature of UBE requires two incisions, the total length of the incisions is longer than that of PELD. In the postoperative follow-up data, the length of hospitalization and time spent on the ground for PELD was shorter than that for UBE, because most of the operations for PELD were performed with local anesthesia, and patients could walk on the ground in a short time after surgery, and the recovery time was also shorter. In the follow-up results, we compared UBE and PELD respectively within the group, and we could see that the postoperative JOA, VAS, ODI and modified Macnab scores of the two groups were significantly improved, indicating that both UBE and PELD quickly solved the symptoms of patients with low back pain and leg pain.At the same time, the comparison between UBE and PELD found that there were no significant differences in JOA, VAS, ODI and modified Macnab scores in the same period after surgery. Therefore, both of them were effective in solving the pain problems of patients, and there was no significant difference in clinical efficacy. In this study, there were 2 cases of dural sac injury in UBE and 1 case of nerve root injury in PELD. The reason for the injury of the dural sac was iatrogenic tear caused by the adhesion of the dural ligament to the dural sac in the process of biting the ligamentum flavum. After the repair of the dural sac and adequate postoperative drainage, the postoperative headache symptoms of the patient were gradually relieved. However, the cause of nerve root injury was caused by excessive pulling of nerve root during exposure to nucleus pulposus. After postoperative symptomatic treatment such as nutritional nerve, the symptoms of lower limb numbness were gradually relieved. In summary, by comparing the clinical efficacy of UBE and PELD in the treatment of lumbar disc herniation, we can conclude that both UBE and PELD are safe, effective and minimally invasive surgical methods for the treatment of single-stage lumbar disc herniation with proficiency in the above two surgical techniques. In addition, UBE is superior to PELD in operational flexibility and radiation exposure, while PELD has more advantages in minimally invasive. The limitations of this study are as follows: 1. The small sample size of this study may lead to data bias; 2. Short follow-up time. Due to the short introduction of UBE and PELD in our hospital, the postoperative follow-up time of patients is limited. Therefore, we will increase the sample size statistics in future studies and extend the follow-up time of patients. Abbreviations UBE: unilateral biportal endoscopic PELD: Percutaneous Endoscopic Lumbar Discectomy JOA: Japanese Orthopaedic Association Scores ODI: Oswestry Dability Index VAS: Visual analogue scale ASA: American society of Aneshesiologists NASS: North American spine society BMI: Body Mass Index CT: Computed Tomography MRI: Magnetic Resonance Imaging Declarations Ethics approval and consent to participate The experimental protocol was established, according to the ethical guidelines of the Helsinki Declaration and was approved by the Human Ethics Committee of The First People's Hospital of Zhaoqing. Written informed consent was obtained from individual or guardian participants. Consent for publication Not applicable Availability of data and materials The datasets and materials are available from corresponding authors on reasonable request. Competing interests The authors declare that they have no competing interests Funding Not applicable Authors' contributions XYX、WS: Drafting the manuscript and Complete the operation. YLL、YYW：collection of Data. XZL: design of methodology. JYX: Application of statistical. CSZ: formulation overarching research goals. Acknowledgements The authors would like to thank all the reviewers who participated in the review. References Deyo R, Mirza S. CLINICAL PRACTICE. Herniated lumbar intervertebral disk. N Engl J Med. 2016;374(18):1763-72. Kreiner DS, Hwang SW, Easa JE, Resnick DK, Baisden JL, Bess S, et al. An evidence-based clinical guideline for the diagnosis and treatment of lumbar disc herniation with radiculopathy. Spine J. 2014;14(1):180-91. Bono CM, Ghiselli G, Gilbert TJ, Kreiner DS, Reitman C, Summers JT, et al. 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Kim JE, Choi DJ, Park EJJ, Lee HJ, Hwang JH, Kim MC, et al. Biportal endoscopic spinal surgery for lumbar spinal stenosis. Asian Spine J. 2019;13(2):334-42. Hong YH, Kim SK, Hwang J, Eum JH, Heo DH, Suh DW, et al. Water dynamics in unilateral biportal endoscopic spine surgery and its related factors: An in vivo proportional regression and proficiency-matched study. World Neurosurg. 2021;149:e836-43. Liu LT, Xue H, Jiang LH, Chen H, Chen LW, Xie SY, et al. Comparison of percutaneous transforaminal endoscopic discectomy and microscope-assisted tubular discectomy for lumbar disc herniation. Orthop Surg. 2021;13(5):1587-95. Yuan CH, Wen BJ, Lin HK. Clinical analysis of minimally invasive percutaneous treatment of severe lumbar disc herniation with UBE two-channel endoscopy and foraminal single-channel endoscopy technique. Oxid Med Cell Longev. 2022;2022:9264852. Jiang HW, Chen CD, Zhan BS, Wang YL, Tang P, Jiang XS. Unilateral biportal endoscopic discectomy versus percutaneous endoscopic lumbar discectomy in the treatment of lumbar disc herniation: A retrospective study. J Orthop Surg Res. 2022;17(1):30. Aygun H, Abdulshafi K. Unilateral biportal endoscopy versus tubular microendoscopy in management of single level degenerative lumbar canal stenosis: A prospective study. Clin Spine Surg. 2021;34(6):E323-8. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted 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. We do this by developing innovative software and high quality services for the global research community. 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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-6149697","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":428812704,"identity":"37d8c58a-e66d-4be8-9caa-12baa3c2bbb4","order_by":0,"name":"Xuyuan Xie","email":"","orcid":"","institution":"Zhujiang Hospital of Southern Medical University","correspondingAuthor":false,"prefix":"","firstName":"Xuyuan","middleName":"","lastName":"Xie","suffix":""},{"id":428812705,"identity":"6b8c6a68-9fd9-43b8-82a5-e366cbb6b906","order_by":1,"name":"Wei Song","email":"","orcid":"","institution":"The First People's Hospital of Zhaoqing","correspondingAuthor":false,"prefix":"","firstName":"Wei","middleName":"","lastName":"Song","suffix":""},{"id":428812706,"identity":"15485840-da65-4c71-8090-6ffecc599580","order_by":2,"name":"Yulu Lu","email":"","orcid":"","institution":"The First People's Hospital of Zhaoqing","correspondingAuthor":false,"prefix":"","firstName":"Yulu","middleName":"","lastName":"Lu","suffix":""},{"id":428812707,"identity":"9ee63e79-3edf-49f9-915f-f74ee0424c2e","order_by":3,"name":"Yueying Wang","email":"","orcid":"","institution":"The First People's Hospital of Zhaoqing","correspondingAuthor":false,"prefix":"","firstName":"Yueying","middleName":"","lastName":"Wang","suffix":""},{"id":428812709,"identity":"dd8d681f-55fd-45cd-bd20-67e217cf693d","order_by":4,"name":"Xuzhou Liu","email":"","orcid":"","institution":"The First People's Hospital of Zhaoqing","correspondingAuthor":false,"prefix":"","firstName":"Xuzhou","middleName":"","lastName":"Liu","suffix":""},{"id":428812711,"identity":"7afbe4f0-67a6-4887-89ac-7707ea84bcb4","order_by":5,"name":"Junyu Xu","email":"","orcid":"","institution":"The First People's Hospital of Zhaoqing","correspondingAuthor":false,"prefix":"","firstName":"Junyu","middleName":"","lastName":"Xu","suffix":""},{"id":428812712,"identity":"f1301993-b88a-4eaf-8e99-9d35a1eed33b","order_by":6,"name":"Chusong Zhou","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAr0lEQVRIiWNgGAWjYFCCBCCusJFjY28/QIqWM2nGfDxnEkjQwth2OHGehIMBcRp029MffvzBlpbeJgHU/KNiG2EtZmceJEvz8Njktkk3HmDsOXObCC03Eo4xM0ik5bbJHEhgZmwjSktiG+MPg8PpbBIJBsRqSWZj4Ek4nECCljPPmKV5DqQZtgED+SBxfjkODLGf/2zk5dvbDz74UUGEFhRwgET1o2AUjIJRMApwAQD0xD0Py0T6BAAAAABJRU5ErkJggg==","orcid":"","institution":"Zhujiang Hospital of Southern Medical University","correspondingAuthor":true,"prefix":"","firstName":"Chusong","middleName":"","lastName":"Zhou","suffix":""}],"badges":[],"createdAt":"2025-03-04 00:53:12","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6149697/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6149697/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":78733834,"identity":"b2ca5f03-51e8-473c-a1b8-a17f6caf7897","added_by":"auto","created_at":"2025-03-18 07:55:17","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":501346,"visible":true,"origin":"","legend":"\u003cp\u003ePreoperative preparation. a. Preliminary positioning of the spinous process line based on surface markers as the posterior midline and upper and lower incisions; b. The left hand is the observation channel, and the right hand is the operation channel; c. The lateral view shows that the sleeve is positioned at the posterior edge of the articular process; d. The radiograph shows that the sleeve is positioned on the inner edge of the pedicle.\u003c/p\u003e","description":"","filename":"figure1.png","url":"https://assets-eu.researchsquare.com/files/rs-6149697/v1/c782d44b4fc05916d21ac39c.png"},{"id":78733842,"identity":"27eda61f-65a1-4f50-ae4c-f2543984acff","added_by":"auto","created_at":"2025-03-18 07:55:18","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":375437,"visible":true,"origin":"","legend":"\u003cp\u003eEndoscopic findings during UBE surgery. a. Expose the edge of the ligamentum flavum and the upper edge of the L5 vertebral body during surgery; b. After biting off the yellow ligament, expose the dura mater and nerve roots; c. Pull the nerve roots and dural sac apart to expose the L4/5 intervertebral disc, and use nucleus pulposus forceps to remove the nucleus pulposus tissue; d. The appearance of the extracted nucleus pulposus.\u003c/p\u003e","description":"","filename":"figure2.png","url":"https://assets-eu.researchsquare.com/files/rs-6149697/v1/11eee40870da162914ad0c0e.png"},{"id":78733835,"identity":"c4f857b1-20fb-4e99-8435-9bcc43c81a88","added_by":"auto","created_at":"2025-03-18 07:55:17","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":526786,"visible":true,"origin":"","legend":"\u003cp\u003eMRI comparison before and after UBE surgery for a 43 year old male patient with L4/5 disc herniation. a. Preoperative MRI sagittal map; b. Preoperative MRI plan view; c. Postoperative MRI sagittal map; d. Postoperative MRI plan view.\u003c/p\u003e","description":"","filename":"figure3.png","url":"https://assets-eu.researchsquare.com/files/rs-6149697/v1/1fef08c1e1e427c63968539d.png"},{"id":78735877,"identity":"9d3632e7-edd0-4d35-a2b0-65eb0961d5a7","added_by":"auto","created_at":"2025-03-18 08:11:18","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":561756,"visible":true,"origin":"","legend":"\u003cp\u003ePreoperative preparation for PELD. a. Based on the surface markers, preliminarily locate the spinous process line as the posterior midline and puncture point; b. Schematic diagram of intervertebral foramen endoscope operation; c. The anteroposterior view shows that the sleeve is located in the ligamentum flavum between the vertebral plates; d. The lateral view shows that the sleeve is positioned at the posterior edge of the vertebral plate.\u003c/p\u003e","description":"","filename":"figure4.png","url":"https://assets-eu.researchsquare.com/files/rs-6149697/v1/3088aceecdce65d4707910ce.png"},{"id":78734701,"identity":"0eb4969b-7b80-4711-9c8d-253871cd5032","added_by":"auto","created_at":"2025-03-18 08:03:18","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":356461,"visible":true,"origin":"","legend":"\u003cp\u003ePreparation status during PELD surgery. a. Use radiofrequency ablation to clean surrounding soft tissue; b. Expose and remove the ligamentum flavum, expose the dura mater and nerve roots; c. Removal of protruding nucleus pulposus and partial intervertebral disc nucleus pulposus tissue using nucleus pulposus forceps; d. Confirm that the nerve root compression has been relieved; e. The removed nucleus pulposus tissue.\u003c/p\u003e","description":"","filename":"figure5.png","url":"https://assets-eu.researchsquare.com/files/rs-6149697/v1/a9e915efd2077075fc95a0a6.png"},{"id":78733839,"identity":"8fb6a0a2-8bf9-4c27-86a4-37487fe036fa","added_by":"auto","created_at":"2025-03-18 07:55:18","extension":"png","order_by":6,"title":"Figure 6","display":"","copyAsset":false,"role":"figure","size":414404,"visible":true,"origin":"","legend":"\u003cp\u003eComparison of MRI before and after PELD surgery for a 60 year old female patient with L5/S1 disc herniation. a. Preoperative MRI sagittal map; b. Preoperative MRI plan view; c. Postoperative MRI sagittal map; d. Postoperative MRI plan view.\u003c/p\u003e","description":"","filename":"figure6.png","url":"https://assets-eu.researchsquare.com/files/rs-6149697/v1/4a8155a1ac28045f32e1638c.png"},{"id":78734702,"identity":"53a6d2b5-579a-46e1-91e5-429a91bdb5c1","added_by":"auto","created_at":"2025-03-18 08:03:18","extension":"png","order_by":7,"title":"Figure 7","display":"","copyAsset":false,"role":"figure","size":898863,"visible":true,"origin":"","legend":"\u003cp\u003eClinical outcomes at different time periods. a.Two groups of improved MacNab; b. JOA, VAS, and ODI scores for two groups.\u003c/p\u003e","description":"","filename":"figure7.png","url":"https://assets-eu.researchsquare.com/files/rs-6149697/v1/1655d13303af51b8653f50b2.png"},{"id":88209525,"identity":"403a9928-08dd-4008-89bf-143a9893c0d7","added_by":"auto","created_at":"2025-08-04 04:31:50","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":4353211,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6149697/v1/d9b10710-58d4-4433-9d8a-c4d015642446.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"The Comparison of unilateral biportal endoscopic (UBE) and Percutaneous Endoscopic Lumbar Discectomy(PELD) in the Treatment of single-level lumbar disc herniation","fulltext":[{"header":"1. Introduction","content":"\u003cp\u003eA lumbar disc herniation occurs when the compressors (one or more of the cartilaginal endplate, nucleus pulposus, or annulus fibrosus) are locally displaced beyond the edge of the disc space, but may not necessarily present clinically [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. When the lumbar disc herniation appears lower limb paresthesia, muscle strength decline, dysfunction is called lumbar disc herniation [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. The pathogenesis of radiculopathy associated with lumbar disc herniation is both biochemical and mechanical, due to the inflammatory response generated by the contact between the protruding nucleus pulposus and nerve roots, which together lead to radiculopathic pain [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. For lumbar disc with the natural course of nerve root disease, NASS(the north American spine society)provides evidence-based advice that the majority of patients after conservative treatment degeneration outstanding intervertebral disc can reduce over time, degradation, changes in plants could also improve independent of treatment [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. However, conservative treatment is not effective for every patient, and timely surgical treatment is required when the symptoms of the patient have not been relieved for more than 3 to 6 months after conservative treatment, or when the symptoms of the cauda equina nerve such as lower limb hypoesthesia, decreased muscle strength, and urinary and bowel dysfunction are combined [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eSurgery for lumbar disc herniation was first proposed by Walter [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e] in 1929 and Mixter [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e] in 1932. In 1938, Dr. GraftonJ.Love modified the procedure, known as the LOVE technique, and the standard procedure is still used today [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. However, the disadvantages of open surgery, such as long incision, more bleeding, and large bone tissue removal area, make patients recover slowly after surgery and stay in hospital for a long time, so orthopedic doctors have been thinking about how to avoid the above situations.The emergence of minimally invasive techniques has greatly avoided most of the disadvantages of open surgery. Yasargil [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e] used a surgical microscope for the first time in 1977 to remove disc herniation [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e], making minimally invasive disc resection technology gradually become the \"gold standard\" for surgical treatment of lumbar disc herniation [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. The advantage of minimally invasive techniques is the ability to treat various types of disc herniations through short approaches to the skin, fascia, and muscles, as well as limited laminectomy or joint removal [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eWith the continuous development of spinal endoscopy technology and the improvement of instruments, its application has been increasingly favored by orthopedic surgeons and patients [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Percutaneous endoscopic lumbar discectomy (PELD) and unilateral biportal endoscopy(UBE) is the two most widely used spinal endoscopic techniques. PELD includes two surgical approaches: transforaminal and translaminal. The transforaminal approach is divided into YESS technique and TESSYS technique. YESS technique is an indirect decompression technique, which has unsatisfactory effects on herniated intervertebral disc, lateral recess stenosis, and foraminal stenosis [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. In view of the shortcomings of YESS technology, Hoogland [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e] improved it in 2003 and developed TESSYS technology, which is to directly decompress lumbar disc herniation by forming the upper articular process with a circular saw under the mirror.In recent years, unilateral dual-channel technique (UBE) has been favored by spinal surgeons due to its smooth learning curve, wide endoscopic field of view and more flexible operation mode, especially in the field of spinal canal decompression, which is more efficient [\u003cspan additionalcitationids=\"CR16 CR17\" citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. The operation mode of UBE is similar to that of arthroscopy, with two channels, namely the visual channel for endoscope placement and the working channel for instrument operation [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. Due to the presence of these two channels, the spine surgeon can easily complete the removal of the disc and the suture of the annulus fibrosus in the working channel [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e].\u003c/p\u003e \u003cp\u003ePrevious studies have shown that lumbar disc herniation can be operated on by the above two endoscopic techniques, however, there are few reports on the comparison of clinical efficacy of the two techniques. Therefore, in order to explore the differences between the two techniques, this paper intends to compare the technical differences between the two by analyzing the postoperative clinical efficacy of patients in the spine surgery department of Zhaoqing First People's Hospital.\u003c/p\u003e"},{"header":"2. Patients and methods","content":"\u003cp\u003eThis study recruited patients with single-level lumbar disc herniation who were hospitalized in the spinal surgery Department of Zhaoqing First People's Hospital from January 2021 to December 2023. All patients were treated with minimally invasive endoscopic spinal surgery. The inclusion criteria of the study were: ① Consistent with the \"international expert consensus on rehabilitation treatment of lumbar disc herniation\", confirmed by CT and magnetic resonance imaging; ② 30–70 years old; ③ Patients with low back pain or radioactive leg pain, with clear indications for surgery; ④ General health condition can be able to withstand surgical anesthesia; ⑤ Complete clinical data and complete follow-up data more than 12 months after surgery. The exclusion criteria are: ① the symptoms are not clear or suspicious; ② History of spinal surgery; ③ Combined with spondylolisthesis, fracture or dislocation, expansion or destruction of vertebral structure; ④ Accompanied by a history of mental illness; ⑤ Recurrent lumbar disc herniation; ⑥Patients with severe infection or tumor or with organic diseases such as heart, liver and kidney, who cannot tolerate surgery; ⑦ Patients with incomplete clinical and follow-up data; ⑧ Loss of visit. After review, a total of 51 patients met the above inclusion criteria and were randomly divided into two groups, one of which underwent UBE surgery; The other group underwent PELD surgery, both performed by the same group of experienced physicians. The institutional review committee of Zhaoqing First People's Hospital approved the study. All patients signed informed consent before operation. This study was conducted in accordance with the ethical standards set out in the Declaration of Helsinki.\u003c/p\u003e\n\u003cp\u003eAfter inclusion exclusion criteria, a total of 51 patients were enrolled in the study, including 33 men and 18 women. They ranged in age from 30 to 70, with an average age of 48. After admission, all patients underwent lumbar MRI, lumbar X-ray anterior-lateral radiography, and lumbar CT examination. JOA, VAS, ODI, and modified MacNab scores were performed by an independent surgeon in all patients after surgery. MRI was performed on all patients after operation to evaluate the curative effect.\u003c/p\u003e\n\u003cdiv id=\"Sec3\"\u003e\n \u003ch2\u003e2.1. Sugical techniques\u003c/h2\u003e\n \u003cp\u003eAll surgeries were performed by the same treatment group of surgeons with more than 15 years of surgical experience.\u003c/p\u003e\n \u003cp\u003eUBE group: Unilateral double-channel surgery (UBE) is usually performed under tracheal intubation and general anesthesia. The patient is in a prone position with the abdomen overhanging at the lumbar bridge. With the aid of the C-arm machine, the responsible segment was positioned by fluoroscope. The spinous process line was initially positioned as the posterior median line according to the body surface marks, and a horizontal line perpendicular to the median line was made parallel to the diseased intervertebral space. A marking point was made at the point 1.5cm above the baseline and 1.5cm below the baseline. A longitudinal incision about 1cm long was made with the above two marks as the center (Fig.\u0026nbsp;1a). Use the sleeve to expand step by step to establish the observation and operation channels (Fig.\u0026nbsp;1c, d). If the lesion is on the left side, the cephalic incision is used as the viewing channel and the caudal incision is used as the operating channel (Fig.\u0026nbsp;1b). Radiofrequency ablation electrodes were used to peel the soft tissue on the surface of the laminae under an endoscopic view to expose structures such as the lower margin of the upper laminae, the upper margin of the lower laminae, the ligamenta flavoides, and the medial facet joints. The lower edge of the upper endplate, the upper edge of the lower endplate, and the inner wall of the facet joint were thinned with an electric grinding drill to reveal the edges and stops of the ligamentum flavoides (Fig.\u0026nbsp;2a). The laminae were then partially removed with laminae lumbar forceps up to the insertion point of the ligamentum flavum. The ligamentum flavum was partially removed to expose the underlying dural sac and nerve root (Fig.\u0026nbsp;2b). A special nerve root retractor was used to pull the dural sac and nerve root apart from the exposed annulus. The annulus was cut open with a sharp knife to expose the protruding nucleus pulposus. The nucleus pulposus was then completely removed from the intervertebral disc using a nucleus pulposus forceps (Fig.\u0026nbsp;2c). Under the microscope, the dural sac and nerve root were found to be in normal shape, and the dural sac returned to pulsation, and there was no obvious tension in the nerve root after the nerve root stripper exploration, indicating that the nerve root had been decompressed. Figure\u0026nbsp;2d demonstrates the nucleus pulposus tissue retrieved through the unilateral biportal endoscopic (UBE) technique. Hemostasis was performed in the operating field, irrigation was closed, irrigation fluid was extruded, and the incision was closed. Walk with waist protection after operation.Preoperative and postoperative MRI examinations were performed to evaluate and compare therapeutic efficacy (Fig.\u0026nbsp;3).\u003c/p\u003e\n \u003cp\u003ePELD group: Patients undergoing unilateral, single-channel (PELD) surgery may be performed under either local infiltration anesthesia or tracheal intubation under general anesthesia. The patient is in a prone position with the abdomen overhanging at the lumbar bridge and the knees and hips in flexion. According to the body surface signs, the spine process line was initially positioned as the posterior median line, and according to the symptoms of the lower extremities of the patient, the left or right approach was determined to make an intersection point between the horizontal line of the diseased vertebral space and the posterior median line. The puncture point of the foraminal approach is at the level of L2/3 and L3/4, generally 8-10cm next to the intersection point, and L4/5 is about 12cm [21]. For the L5/S1 segment, the interlaminar approach is generally chosen due to the occlusion of the iliac crest (Fig.\u0026nbsp;4a). Taking L5/S1 as an example, the puncture point was marked, and the puncture needle and sleeve were inserted at the fixation point under C-arm perspective. The sleeve was located at the junction between the middle vertical line of the interlaminar space on one side of the midline of the spinous process and the upper and lower laminae on the anteriorview (Fig.\u0026nbsp;4c), and the distal end of the sleeve was located on the surface of the laminae on the lateral view (Fig.\u0026nbsp;4d). After the position of the working channel was confirmed, foramicroscope was inserted (Fig.\u0026nbsp;4b), and radio-frequency knife head was used to stop bleeding and remove the surrounding soft tissue (Fig.\u0026nbsp;5a). The L5/S1 interlaminar ligamentum flandum was exposed (Fig.\u0026nbsp;5b), and part of the ligamentum flandum was removed with blue forceps, the dural sac and nerve root were exposed, and the nucleus pulposus tissue protruded within the intervertebral disc was removed with nucleus pulposus forceps (Fig.\u0026nbsp;5c). The residual nucleus pulposus debris was explored and removed to fully decompress the compressed nerve root (Fig.\u0026nbsp;5d). After endoscopic cleaning of the surrounding nerve roots, it was confirmed that the dural and nerve roots were fully loosened without active bleeding, and the foraminal mirror and sleeve were withdrawn and the incision was sutured. Figure\u0026nbsp;5e demonstrates the nucleus pulposus tissue retrieved through the percutaneous endoscopic lumbar discectomy (PELD) technique. On the day after surgery, straight leg elevation training can be performed on the bed, and on the first day after surgery, patients can walk under the protection of the waist.Preoperative and postoperative MRI examinations were performed to evaluate and compare therapeutic efficacy (Fig.\u0026nbsp;6).\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec4\"\u003e\n \u003ch2\u003e2.2. Follow-up protocol\u003c/h2\u003e\n \u003col\u003e\n \u003cli\u003e\n \u003cp\u003ePerioperative management: Antibiotics were used once during operation and once after operation. Walk with girth protection on day 1–3 after surgery. Brake for 4–6 weeks, and heavy physical labor is prohibited within 3–6 months. X-ray and MRI were re-examined after operation to understand the operation situation.\u003c/p\u003e\n \u003c/li\u003e\n \u003cli\u003e\n \u003cp\u003eOutcome measures: Preoperative observation contents: ① Age; ② Gender; ③BMI; ④ ASA; ⑤ Responsibility section; ⑥ Follow-up time; ⑦ Duration of disease; Preoperative VAS, ODI and JOA scores. Intraoperative observation: ① Blood loss; ② Operation time ③ Anesthesia time; ④Intraoperative fluoroscopy times; ⑤Length of surgical incision; Postoperative observation contents: ① VAS scores 1 week and 1 and 12 months after surgery;② ODI scores 1 week and 1 and 12 months after surgery; ③ JOA score 1 week and 1 and 12 months after surgery; ④ Postoperative hospital stay; ⑤ Improved Macnab score after operation; ⑥ Time to walk.\u003c/p\u003e\n \u003c/li\u003e\n \u003c/ol\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec5\"\u003e\n \u003ch2\u003e2.3. Statistical analysis\u003c/h2\u003e\n \u003cp\u003eStatistics and analysis of all data in this study were performed using SPSS23.0. Categorical variables are expressed as frequency and percentage, while continuous variables are expressed as mean ± SD/ mean ± SD (median). For continuous variables showing a normal distribution, students' t test is used to compare the two groups. For parameters that do not display normal distribution, Mann-WhitneyU test is used. For categorical variables, Pearson chi-square test and Fisher exact chi-square test are used. In all statistical analyses, a value of P \u0026lt; 0.05 is considered to be significantly different.\u003c/p\u003e\n\u003c/div\u003e"},{"header":"3. Results","content":"\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003e3.1. Preoperative information of patients\u003c/h2\u003e \u003cp\u003eA comparison of the demographic statistics and typing characteristics of the two groups is shown in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. A total of 51 eligible patients were enrolled from January 2021 to December 2023. Of these, 23 were in the UBE group and 28 were in the PELD group. In the UBE group, there were 112 L5/S112 patients and 10 non-L5 /S1 patients. The mean age of the patients was 51 years old, BMI was 23.9, and the ASA evaluation score of anesthesia was 19 patients (1\u0026ndash;2 patients) and 4 patients (3\u0026ndash;4 patients). The mean follow-up time was 13.7 months. In the PELD group, there were 10 patients with L5/S1 and 18 patients with non-L5 /S1. The average age of patients was 46.57 years old, BMI was 24.97, and the ASA evaluation score of anesthesia was 1\u0026ndash;2 points for 24 patients, and 3\u0026ndash;4 points for 4 patients. The average follow-up time was 13.7 months. There were no significant differences between the two groups in gender, age, anesthesia ASA score, responsible segment composition, Pfirrmann grade of disc degeneration, and follow-up time.\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\u003eGeneral patient condition data\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=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" 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\u003eTotal patient (n\u0026thinsp;=\u0026thinsp;51)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eUBE (n\u0026thinsp;=\u0026thinsp;23)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePELD (n\u0026thinsp;=\u0026thinsp;28)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender (%)\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 \u003cp\u003e0.268a\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e33 (64.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e13 (56.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e20 (71.4)\u003c/p\u003e \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\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e18 (35.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e10 (43.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e8 (28.6)\u003c/p\u003e \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\u003eAge(years), mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e48.86\u0026thinsp;\u0026plusmn;\u0026thinsp;12.57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e51.65\u0026thinsp;\u0026plusmn;\u0026thinsp;14.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e46.57\u0026thinsp;\u0026plusmn;\u0026thinsp;10.95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.153d\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBMI, men\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e23.49\u0026thinsp;\u0026plusmn;\u0026thinsp;4.09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e23.90\u0026thinsp;\u0026plusmn;\u0026thinsp;3.62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e24.97\u0026thinsp;\u0026plusmn;\u0026thinsp;4.44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.364c\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eASA (%)\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 \u003cp\u003e0.762b\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u0026ndash;2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e43 (84.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e19 (82.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e24 (85.7)\u003c/p\u003e \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\u003e3\u0026ndash;4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e8 (15.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4 (17.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4 (14.3)\u003c/p\u003e \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\u003eResponsible levels (%)\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 \u003cp\u003e0.238a\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eL5/S1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e22 (43.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e12 (52.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e10 (35.7)\u003c/p\u003e \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\u003eOthers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e29 (56.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e11 (47.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e18 (64.3)\u003c/p\u003e \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\u003ePfirrmann Classification (%)\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 \u003cp\u003e0.741a\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIII\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e24 (47.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8 (34.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e11 (39.3)\u003c/p\u003e \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\u003eIV\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e27 (52.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e15 (65.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e17 (60.7)\u003c/p\u003e \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\u003eFollow up time\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e13.73\u0026thinsp;\u0026plusmn;\u0026thinsp;1.65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e13.74\u0026thinsp;\u0026plusmn;\u0026thinsp;1.84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e13.71\u0026thinsp;\u0026plusmn;\u0026thinsp;1.51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.897c\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003ea: Pearson Chi-Square test. b: Fisher exact test. c: Mann-Whitney U test. d: Student t test.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003e3.2. Intraoperative statistical data\u003c/h2\u003e \u003cp\u003eThe comparison of data between the two groups is shown in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. During each operation, the operative time, anesthesia method and time, intraoperative fluoroscopy times, blood loss, incision length, dural and nerve root injury were counted. All anesthesia methods of UBE were general anesthesia, while 20 cases of PELD were local anesthesia and 8 cases were general anesthesia. The operative time of UBE was longer than that of PELD, which was statistically significant. The duration of anesthesia of UBE was also longer than PELD, which was statistically significant. Both blood loss and incision length were longer in UBE than in PELD. However, the fluoroscopy frequency of UBE was less than that of PELD, which was statistically significant. During the operation, there were 2 cases of dural sac injury in UBE and 1 case of nerve root pulling injury in PELD.\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\u003eIntraoperative situation data\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\u003eTotal patient (n\u0026thinsp;=\u0026thinsp;51)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eUBE (n\u0026thinsp;=\u0026thinsp;23)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePELD (n\u0026thinsp;=\u0026thinsp;28)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAnesthesia\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 \u003cp\u003e\u0026lt;\u0026thinsp;0.01b\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGeneral\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e23 (45.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e23 (100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8 (28.6)\u003c/p\u003e \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\u003eLocal infiltration\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e28(54.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (0.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e20 (71.4)\u003c/p\u003e \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\u003eProcedure time\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e140.98\u0026thinsp;\u0026plusmn;\u0026thinsp;50.03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e165.00\u0026thinsp;\u0026plusmn;\u0026thinsp;61.22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e121.25\u0026thinsp;\u0026plusmn;\u0026thinsp;26.20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.012c\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAnesthesia time\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e168.47\u0026thinsp;\u0026plusmn;\u0026thinsp;58.40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e208.13\u0026thinsp;\u0026plusmn;\u0026thinsp;58.13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e135.89\u0026thinsp;\u0026plusmn;\u0026thinsp;33.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.01c\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBlood loss\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12.53\u0026thinsp;\u0026plusmn;\u0026thinsp;7.70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16.96\u0026thinsp;\u0026plusmn;\u0026thinsp;9.26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8.89\u0026thinsp;\u0026plusmn;\u0026thinsp;3.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.01c\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIntraoperative fluoroscopy times\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8.67\u0026thinsp;\u0026plusmn;\u0026thinsp;2.90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6.52\u0026thinsp;\u0026plusmn;\u0026thinsp;2.11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10.43\u0026thinsp;\u0026plusmn;\u0026thinsp;2.20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;0.01c\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIncisive length\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15.67\u0026thinsp;\u0026plusmn;\u0026thinsp;6.83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e22.61\u0026thinsp;\u0026plusmn;\u0026thinsp;2.92\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9.96\u0026thinsp;\u0026plusmn;\u0026thinsp;2.15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.01c\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDural sac tear\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \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\u003eNerve injury\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003ea: Pearson Chi-Square test. b: Fisher exact test. c: Mann-whitney U test. d: Student t test.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003e3.3. Postoperative and follow-up statistics\u003c/h2\u003e \u003cp\u003eWe analyzed the scores of patients after UBE and PELD surgery (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e and Fig.\u0026nbsp;\u003cspan refid=\"Fig7\" class=\"InternalRef\"\u003e7\u003c/span\u003e). Compared with before treatment, VAS, JOA score and ODI index of 2 groups were significantly improved 1 week after surgery, and the difference was statistically significant. There was no significant difference in VAS, JOA score and ODI index before surgery, 1 month and 1 year after surgery.\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\u003ePostoperative Follow up Data\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\u003eTotal patient (n\u0026thinsp;=\u0026thinsp;51)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eUBE (n\u0026thinsp;=\u0026thinsp;23)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePELD (n\u0026thinsp;=\u0026thinsp;28)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePost-operative hospital\u0026rsquo;s day (days), mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD (median)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5.88\u0026thinsp;\u0026plusmn;\u0026thinsp;1.99\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6.78\u0026thinsp;\u0026plusmn;\u0026thinsp;2.13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5.14\u0026thinsp;\u0026plusmn;\u0026thinsp;1.56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.020c\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDVT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \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\u003esuperficial wound infections\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \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\u003eVAS Score, mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD (median)\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\u003ePre-operative\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7.59\u0026thinsp;\u0026plusmn;\u0026thinsp;1.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7.43\u0026thinsp;\u0026plusmn;\u0026thinsp;1.04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7.46\u0026thinsp;\u0026plusmn;\u0026thinsp;1.45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.576c\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePost-operative\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.43\u0026thinsp;\u0026plusmn;\u0026thinsp;0.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.43\u0026thinsp;\u0026plusmn;\u0026thinsp;0.51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.43\u0026thinsp;\u0026plusmn;\u0026thinsp;0.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.965c\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eJOA Score, mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD (median)\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\u003ePre-operative\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11.49\u0026thinsp;\u0026plusmn;\u0026thinsp;1.91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12.13\u0026thinsp;\u0026plusmn;\u0026thinsp;1.60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10.96\u0026thinsp;\u0026plusmn;\u0026thinsp;2.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.431c\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePost-operative\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e24.86\u0026thinsp;\u0026plusmn;\u0026thinsp;1.37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e24.96\u0026thinsp;\u0026plusmn;\u0026thinsp;1.11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e24.79\u0026thinsp;\u0026plusmn;\u0026thinsp;1.57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.735c\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eODI Score, mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD (median)\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\u003ePre-operative\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e59.16\u0026thinsp;\u0026plusmn;\u0026thinsp;2.86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e58.26\u0026thinsp;\u0026plusmn;\u0026thinsp;2.77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e59.89\u0026thinsp;\u0026plusmn;\u0026thinsp;2.77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.037c\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePost-operative\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10.14\u0026thinsp;\u0026plusmn;\u0026thinsp;1.67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9.83\u0026thinsp;\u0026plusmn;\u0026thinsp;1.70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10.39\u0026thinsp;\u0026plusmn;\u0026thinsp;1.64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.211c\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMacnab score\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 \u003cp\u003e0.809b\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eExcellent and good\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e46 (90.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21 (91.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e25 (89.3)\u003c/p\u003e \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\u003eFair and poor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5 (9.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (8.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3 (9.7)\u003c/p\u003e \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\u003ePostoperative walking time on the ground (d)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.94\u0026thinsp;\u0026plusmn;\u0026thinsp;1.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.83\u0026thinsp;\u0026plusmn;\u0026thinsp;0.78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.21\u0026thinsp;\u0026plusmn;\u0026thinsp;0.42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.01c\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003ea: Pearson Chi-Square test. b: Fisher exact test. c: Mann-whitney U test. d: Student t test.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eAt one year after surgery, the overall curative effect rate was 91.3% in the UBE group and 89.3% in the PELD group according to the MacNab standard, and there was no statistically significant difference between the two groups.\u003c/p\u003e \u003c/div\u003e"},{"header":"4. Discussion","content":"\u003cp\u003eWith the development of minimally invasive spinal surgery, spinal endoscopy has gradually replaced the traditional open surgery and become the main surgical method for LDH. Due to the features of minimally invasive incision, small damage to muscle and bone, and short hospital stay, spinal endoscopy greatly alleviates postoperative low back pain and spinal instability of patients, so it is widely accepted and applied in clinical practice by spinal surgeons [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. UBE and PELD are the most widely used minimally invasive techniques in the field of spinal minimally invasive techniques. PELD is a single-channel spinal endoscopy technique that combines the viewing, operating, and irrigating channels into one channel and is operated with a series of specialized instruments. PELD includes the lateral foraminal approach and the dorsal interlaminar approach, and the sacrospinous muscle is not dissected during the operation, which avoids chronic low back pain caused by denerinnervation during the operation, and part of PELD can be performed under local anesthesia to facilitate communication with patients, thus reducing the risk of nerve injury. UBE is a dual-channel spinal endoscopy technique. The difference between this technique and PELD is that UBE is composed of two channels, including observation channel and operation channel, with dedicated instruments for intraspinal decompression or removal of the nucleus pulposus. Because the biggest feature of UBE is the separation of the observation channel and the operating channel, it has a wider surgical field of view and a more flexible operating space. Previous relevant literature reports also show that UBE has a smoother learning curve [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e] and has more obvious advantages in promotion.\u003c/p\u003e \u003cp\u003eIn this study, there were no significant differences in preoperative gender, age, anesthesia ASA score, responsible segment composition, disc classification, and follow-up time between the UBE and PELD groups. In comparison of intraoperative conditions, all patients in UBE group underwent general anesthesia, while PELD had two anesthesia methods: general anesthesia or local anesthesia. The reason was that during UBE surgery, special nerve root retractor was needed to stretch the compressed nerve root to expose the protruded nucleus pulposus. Patients could not tolerate pain during this process, so all patients in UBE group underwent general anesthesia. The main difference between the two anesthesia methods in PELD group was the difference at the responsible level. In L5/S1 segment, the surgical approach was interlaminar approach, so general anesthesia was used, while in non-L5/S1 segment, foraminal approach was used, so local anesthesia was used, so as to facilitate communication with patients and avoid nerve root damage. In addition, the duration of operation and anesthesia in the UBE group was higher than that in the PELD group, which had different results from previous literature reports [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. The reason is that PELD surgery was carried out earlier than UBE surgery in our hospital, so PELD technology has crossed the learning curve and reached a stable stage, while UBE technology is in the process of crossing the learning curve, so its proficiency is not good. With the increase of surgical experience, it may be possible to significantly reduce the length of surgery and anesthesia. However, the number of fluoroscopy in UBE group is significantly lower than that in PELD group, because UBE technology adopts interlaminar approach, convenient positioning, and does not need to adjust the direction and Angle of the puncture needle repeatedly, which can reduce the amount of radiation received by the operator and the patient. UBE needs to strip more soft tissue during surgery, so it needs to perform multiple hemostatic operations, which also makes UBE bleed more than PELD. In addition, because the dual channel nature of UBE requires two incisions, the total length of the incisions is longer than that of PELD. In the postoperative follow-up data, the length of hospitalization and time spent on the ground for PELD was shorter than that for UBE, because most of the operations for PELD were performed with local anesthesia, and patients could walk on the ground in a short time after surgery, and the recovery time was also shorter. In the follow-up results, we compared UBE and PELD respectively within the group, and we could see that the postoperative JOA, VAS, ODI and modified Macnab scores of the two groups were significantly improved, indicating that both UBE and PELD quickly solved the symptoms of patients with low back pain and leg pain.At the same time, the comparison between UBE and PELD found that there were no significant differences in JOA, VAS, ODI and modified Macnab scores in the same period after surgery. Therefore, both of them were effective in solving the pain problems of patients, and there was no significant difference in clinical efficacy.\u003c/p\u003e \u003cp\u003eIn this study, there were 2 cases of dural sac injury in UBE and 1 case of nerve root injury in PELD. The reason for the injury of the dural sac was iatrogenic tear caused by the adhesion of the dural ligament to the dural sac in the process of biting the ligamentum flavum. After the repair of the dural sac and adequate postoperative drainage, the postoperative headache symptoms of the patient were gradually relieved. However, the cause of nerve root injury was caused by excessive pulling of nerve root during exposure to nucleus pulposus. After postoperative symptomatic treatment such as nutritional nerve, the symptoms of lower limb numbness were gradually relieved.\u003c/p\u003e \u003cp\u003eIn summary, by comparing the clinical efficacy of UBE and PELD in the treatment of lumbar disc herniation, we can conclude that both UBE and PELD are safe, effective and minimally invasive surgical methods for the treatment of single-stage lumbar disc herniation with proficiency in the above two surgical techniques. In addition, UBE is superior to PELD in operational flexibility and radiation exposure, while PELD has more advantages in minimally invasive.\u003c/p\u003e \u003cp\u003eThe limitations of this study are as follows: 1. The small sample size of this study may lead to data bias; 2. Short follow-up time. Due to the short introduction of UBE and PELD in our hospital, the postoperative follow-up time of patients is limited. Therefore, we will increase the sample size statistics in future studies and extend the follow-up time of patients.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eUBE: unilateral biportal endoscopic\u003c/p\u003e\n\u003cp\u003ePELD: Percutaneous Endoscopic Lumbar Discectomy\u003c/p\u003e\n\u003cp\u003eJOA: Japanese Orthopaedic Association Scores\u003c/p\u003e\n\u003cp\u003eODI: Oswestry Dability Index\u003c/p\u003e\n\u003cp\u003eVAS: Visual analogue scale\u003c/p\u003e\n\u003cp\u003eASA: American society of Aneshesiologists\u003c/p\u003e\n\u003cp\u003eNASS: North American spine society\u003c/p\u003e\n\u003cp\u003eBMI: Body Mass Index\u003c/p\u003e\n\u003cp\u003eCT: Computed Tomography\u003c/p\u003e\n\u003cp\u003eMRI: Magnetic Resonance Imaging\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe experimental protocol was established, according to the ethical guidelines of the Helsinki Declaration and was approved by the Human Ethics Committee of The First People\u0026apos;s Hospital of Zhaoqing. Written informed consent was obtained from individual or guardian participants.\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\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets and materials are available from corresponding authors on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eXYX、WS: Drafting the manuscript and Complete the operation. YLL、YYW：collection of Data. XZL: design of methodology. JYX: Application of statistical. CSZ: formulation overarching research goals.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors would like to thank all the reviewers who participated in the review.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eDeyo R, Mirza S. CLINICAL PRACTICE. Herniated lumbar intervertebral disk. N Engl J Med. 2016;374(18):1763-72.\u003c/li\u003e\n\u003cli\u003eKreiner DS, Hwang SW, Easa JE, Resnick DK, Baisden JL, Bess S, et al. An evidence-based clinical guideline for the diagnosis and treatment of lumbar disc herniation with radiculopathy. Spine J. 2014;14(1):180-91.\u003c/li\u003e\n\u003cli\u003eBono CM, Ghiselli G, Gilbert TJ, Kreiner DS, Reitman C, Summers JT, et al. An evidence-based clinical guideline for the diagnosis and treatment of cervical radiculopathy from degenerative disorders. Spine J. 2011;11(1):64-72.\u003c/li\u003e\n\u003cli\u003eKhanna P, Sarkar S, Garg B. Anesthetic considerations in spine surgery: What orthopaedic surgeon should know! J Clin Orthop Trauma. 2020;11(5):742-8.\u003c/li\u003e\n\u003cli\u003eDandy WE. Loose cartilage from intervertebral disk simulating tumor of the spinal cord. Clin Orthop Relat Res. 1989;(238):4-8.\u003c/li\u003e\n\u003cli\u003eMixter WJ, Barr JS. Rupture of the intervertebral disc with involvement of the spinal canal. N Engl J Med. 1934;211:210-5.\u003c/li\u003e\n\u003cli\u003eChedid KJ, Chedid MK. The \u0026quot;tract\u0026quot; of history in the treatment of lumbar degenerative disc disease. Neurosurg Focus. 2004;16(1):E7.\u003c/li\u003e\n\u003cli\u003eLove JG. Protruded intervertebral disc (Fibrocartilage): (Section of Orthop\u0026aelig;dics and Section of Neurology). Proc R Soc Med. 1939;32(12):1697-721.\u003c/li\u003e\n\u003cli\u003eYasargil MG, Vise WM, Bader DC. Technical adjuncts in neurosurgery. Surg Neurol. 1977;8(5):331-6.\u003c/li\u003e\n\u003cli\u003ePostacchini F, Postacchini R. Operative management of lumbar disc herniation: The evolution of knowledge and surgical techniques in the last century. Acta Neurochir Suppl. 2011;108:17-21.\u003c/li\u003e\n\u003cli\u003eAlvi MA, Kerezoudis P, Wahood W, Goyal A, Bydon M. Operative approaches for lumbar disc herniation: A systematic review and multiple treatment meta-analysis of conventional and minimally invasive surgeries. World Neurosurg. 2018;114:391-407.e2.\u003c/li\u003e\n\u003cli\u003eSimpson AK, Lightsey HM 4th, Xiong GX, Crawford AM, Minamide A, Schoenfeld AJ. Spinal endoscopy: Evidence, techniques, global trends, and future projections. Spine J. 2022;22(1):64-74.\u003c/li\u003e\n\u003cli\u003eDeen HG. Posterolateral endoscopic excision for lumbar disc herniation: surgical technique, outcome, and complications in 307 consecutive cases. Spine (Phila Pa 1976). 2002;27(18):2081-2; author reply 2081-2.\u003c/li\u003e\n\u003cli\u003eHoogland T, Schubert M, Miklitz B, Ramirez A. Transforaminal posterolateral endoscopic discectomy with or without the combination of a low-dose chymopapain: A prospective randomized study in 280 consecutive cases. Spine (Phila Pa 1976). 2006;31(24):E890-7.\u003c/li\u003e\n\u003cli\u003eChoi DJ, Kim JE. Efficacy of biportal endoscopic spine surgery for lumbar spinal stenosis. Clin Orthop Surg. 2019;11(1):82-8.\u003c/li\u003e\n\u003cli\u003eHeo DH, Quillo-Olvera J, Park CK. Can percutaneous biportal endoscopic surgery achieve enough canal decompression for degenerative lumbar stenosis? Prospective case-control study. World Neurosurg. 2018;120:e684-9.\u003c/li\u003e\n\u003cli\u003eKang T, Park SY, Kang CH, Lee SH, Park JH, Suh SW. Is biportal technique/endoscopic spinal surgery satisfactory for lumbar spinal stenosis patients?: A prospective randomized comparative study. Medicine (Baltimore). 2019;98(18):e15451.\u003c/li\u003e\n\u003cli\u003eMin WK, Kim JE, Choi DJ, Park EJ, Heo J. Clinical and radiological outcomes between biportal endoscopic decompression and microscopic decompression in lumbar spinal stenosis. J Orthop Sci. 2020;25(3):371-8.\u003c/li\u003e\n\u003cli\u003eKim JE, Choi DJ, Park EJJ, Lee HJ, Hwang JH, Kim MC, et al. Biportal endoscopic spinal surgery for lumbar spinal stenosis. Asian Spine J. 2019;13(2):334-42.\u003c/li\u003e\n\u003cli\u003eHong YH, Kim SK, Hwang J, Eum JH, Heo DH, Suh DW, et al. Water dynamics in unilateral biportal endoscopic spine surgery and its related factors: An in vivo proportional regression and proficiency-matched study. World Neurosurg. 2021;149:e836-43.\u003c/li\u003e\n\u003cli\u003eLiu LT, Xue H, Jiang LH, Chen H, Chen LW, Xie SY, et al. Comparison of percutaneous transforaminal endoscopic discectomy and microscope-assisted tubular discectomy for lumbar disc herniation. Orthop Surg. 2021;13(5):1587-95.\u003c/li\u003e\n\u003cli\u003eYuan CH, Wen BJ, Lin HK. Clinical analysis of minimally invasive percutaneous treatment of severe lumbar disc herniation with UBE two-channel endoscopy and foraminal single-channel endoscopy technique. Oxid Med Cell Longev. 2022;2022:9264852.\u003c/li\u003e\n\u003cli\u003eJiang HW, Chen CD, Zhan BS, Wang YL, Tang P, Jiang XS. Unilateral biportal endoscopic discectomy versus percutaneous endoscopic lumbar discectomy in the treatment of lumbar disc herniation: A retrospective study. J Orthop Surg Res. 2022;17(1):30.\u003c/li\u003e\n\u003cli\u003eAygun H, Abdulshafi K. Unilateral biportal endoscopy versus tubular microendoscopy in management of single level degenerative lumbar canal stenosis: A prospective study. Clin Spine Surg. 2021;34(6):E323-8.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"lumbar disc herniation, unilateral biportal endoscopic discectomy, percutaneous foramicroscopy, Minimally invasive surgery invasive surgery","lastPublishedDoi":"10.21203/rs.3.rs-6149697/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6149697/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e: The objective of this study was to compare the clinical efficacy of unilateral dual-channel spinal endoscopy (UBE) and percutaneous foraminoscopy (PELD) in the treatment of single-level disc herniation.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePatients and Methods:\u003c/strong\u003e This study recruited patients with lumbar disc herniation who were hospitalized in the spinal surgery Department of Zhaoqing First People's Hospital from January 2021 to December 2023. A total of 51 patients underwent minimally invasive spinal endoscopy, including 23 in the UBE group and 28 in the PELD group.All patients were followed for at least 1 year. Demographic characteristics, Pfirrmann grade, intraoperative and postoperative data, complications and prognostic indicators of intervertebral disc degeneration were analyzed in the two groups. Japanese Orthopaedic Association scores (JOA score), Oswestry disability index (ODI index), visual analog scale (VAS score), and modified macnab criteria were used to evaluate all clinical outcomes.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003eThere were no significant differences in demographic characteristics between the two groups, including gender, age, anesthesia ASA score, responsible segment composition, follow-up time and Pfirrmann grade of disc degeneration. PELD was superior to UBE in terms of operation and anesthesia time, blood loss and incision length (p \u0026lt; 0.05), suggesting that PELD is more minimally invasive. However, the intraoperative fluoroscopy of UBE is significantly less than that of PELD (p \u0026lt; 0.05), so that the surgeon receives less radiation. There were no significant differences in the scores of JOA, VAS, ODI and modified Macnab between the two groups after surgery (p \u0026gt; 0.05), but the scores of JOA, VAS, ODI and modified Macnab after surgery in the two groups were improved compared with those before surgery, with significant statistical significance (p \u0026lt; 0.05).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion: \u003c/strong\u003eUBE and PELD are safe and effective in the treatment of single segment lumbar disc herniation. UBE has a wider intraoperative field of view and more flexible operation. PELD surgery is less invasive, and perioperative recovery is faster, but it is more difficult to operate.\u003c/p\u003e","manuscriptTitle":"The Comparison of unilateral biportal endoscopic (UBE) and Percutaneous Endoscopic Lumbar Discectomy(PELD) in the Treatment of single-level lumbar disc herniation","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-03-18 07:55:13","doi":"10.21203/rs.3.rs-6149697/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"3109d8f1-31b8-4819-bede-dc3933b494dc","owner":[],"postedDate":"March 18th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":45684077,"name":"Biological sciences/Neuroscience/Spine regulation and structure/Spine structure"},{"id":45684078,"name":"Health sciences/Neurology/Neurological disorders"}],"tags":[],"updatedAt":"2025-08-04T04:23:42+00:00","versionOfRecord":[],"versionCreatedAt":"2025-03-18 07:55:13","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6149697","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6149697","identity":"rs-6149697","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}