Comparison of the therapeutic effects of unilateral biportal endoscopic discectomy and percutaneous endoscopic interlaminar discectomy in the treatment of lumbar disc herniation

Comparison of the therapeutic effects of unilateral biportal endoscopic discectomy and percutaneous endoscopic interlaminar discectomy in the treatment of 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 Comparison of the therapeutic effects of unilateral biportal endoscopic discectomy and percutaneous endoscopic interlaminar discectomy in the treatment of lumbar disc herniation chengzhou liu, wei zhang, Cheng-Yue Zhu, Feng Shen, Bao-Xin jia, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6338564/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 Objectives Over recent years, minimally invasive spine surgery has seen rapid advancement, with Unilateral Biportal Endoscopy (UBE) and Percutaneous Endoscopic Interlaminar Discectomy (PEID) emerging as increasingly important techniques for the treatment of lumbar disc herniation. The UBE technique involves the creation of two small incisions on one side of the patient's spine, offering flexibility and precision during surgery. In contrast, the PEID technique establishes a working channel through percutaneous puncture, performing the procedure under endoscopic visualization. Although both techniques are increasingly adopted, comparative studies remain limited. This study aims to compare the clinical efficacy of UBE and PEID in the management of lumbar disc herniation, with the goal of providing clinicians with more evidence-based treatment options. Methods A total of 117 patients diagnosed with lumbar disc herniation were treated at three spinal centers: Linqu County People's Hospital, Hangzhou Traditional Chinese Medicine Hospital, and Qingdao University Affiliated Hospital, between April 2023 and March 2024. Based on the surgical technique chosen, patients were divided into two groups: the UBE group (52 patients undergoing Unilateral Biportal Endoscopy) and the PEID group (65 patients undergoing Percutaneous Endoscopic Interlaminar Discectomy). Various surgical parameters, including operative time, blood loss, complication rates, X-ray exposure, and other clinical outcomes, were compared between the two groups. The Visual Analog Scale (VAS) and Oswestry Disability Index (ODI) scores were evaluated preoperatively, and at 1 and 6 months postoperatively. Additionally, the cross-sectional area of the dural sac was measured preoperatively and 1 month postoperatively. Results Baseline characteristics, including age, gender, and duration of symptoms, were comparable between the two groups ( P >0.05). For patients undergoing unilateral decompression, there was no significant difference in operative time between the two groups ( P >0.05). However, for patients requiring bilateral decompression, the UBE group demonstrated significantly shorter operative times compared to the PEID group ( P 0.05). Nevertheless, the UBE group incurred significantly higher hospitalization costs than the PEID group ( P <0.05). Postoperatively, both groups showed significant improvements in VAS scores ( P < 0.05) and ODI scores ( P <0.05), with a notable increase in the cross-sectional area of the dural sac ( P <0.05). Additionally, the UBE group exhibited a larger postoperative cross-sectional area of the dural sac compared to the PEID group ( P <0.05). Conclusions Both UBE and PEID are effective techniques for treating lumbar disc herniation. For patients with unilateral symptoms, both methods yield comparable outcomes, with PEID associated with lower hospitalization costs. For patients with bilateral symptoms, UBE offers a shorter operative time and superior postoperative outcomes. Health sciences/Medical research/Study design/Randomized controlled trials Health sciences/Health occupations/Orthopaedics Unilateral Biportal Endoscopy Percutaneous Endoscopic Interlaminar discectomy Lumbar Disc Herniation Lumbar Spinal Stenosis Figures Figure 1 Figure 2 Figure 3 Introduction Lumbar disc herniation is a common and frequently encountered condition in spinal surgery, primarily presenting with low back pain accompanied by radiating pain and numbness in the lower extremities. While the majority of lumbar disc herniation cases improve with conservative management, a subset of patients still require surgical intervention. In recent years, with ongoing advancements in medical technology, spinal endoscopy has emerged as a widely utilized and promising technique for the treatment of lumbar disc herniation. Both Unilateral Biportal Endoscopy (UBE) and Percutaneous Endoscopic Interlaminar Discectomy (PEID) have demonstrated favorable outcomes in treating this condition [ 1 – 3 ]. The development of fully visualized endoscopic techniques, along with the Endo-Surg concept that incorporates an open-surgery-like perspective into endoscopic procedures, has significantly improved the precision of spinal endoscopy. Surgeons can now operate in a highly visualized field, similar to open surgery, allowing for accurate identification of spinal structures and minimizing the risk of inadvertent damage to surrounding healthy tissues. UBE has experienced remarkable development in recent years, with the technique becoming increasingly refined and its indications expanding [ 4 ]. Compared to single-channel endoscopy, dual-channel technology provides a larger operative space, clearer visualization, and separation of the observation and operative channels, thus making the procedure more efficient, flexible, and easier to perform [ 5 ]. Although both techniques have shown promising results, there is a limited body of comparative research on UBE and PEID for the treatment of lumbar disc herniation. This study aims to conduct a comparative analysis of the clinical efficacy of UBE and PEID in treating lumbar disc herniation, with the objective of optimizing treatment strategies and enhancing patient outcomes and prognosis. Materials and methods A total of 117 patients diagnosed with lumbar disc herniation were enrolled in this study from three spine centers at Linqu County People's Hospital, Hangzhou Traditional Chinese Medicine Hospital, and Qingdao University Affiliated Hospital between April 2023 and March 2024. Among them, 56 were male and 61 were female, with ages ranging from 18 to 83 years (mean age: 54.63 ± 14.90 years). The distribution of affected segments was as follows: 15 cases involved the L3/4 segment, 50 cases the L4/5 segment, and 52 cases the L5/S1 segment. Clinically, 83 patients presented with unilateral lower limb symptoms, while 34 exhibited symptoms in both lower limbs. All patients provided written informed consent, and the study was approved by the institutional ethics committees of the respective hospitals. Inclusion and exclusion criteria Inclusion criteria All patients met the diagnostic criteria for lumbar disc herniation [ 6 ], exhibiting typical clinical manifestations such as unilateral or bilateral lower limb pain and numbness, which were consistent with imaging findings. The lesions were confined to a single spinal level. Complete clinical data were available for all patients. Prior to admission, patients had undergone conservative treatment for a minimum of three months, with no significant improvement or worsening of symptoms. All patients underwent either unilateral biportal endoscopic spinal surgery or percutaneous interlaminar endoscopic spinal surgery following comprehensive preoperative evaluations. Exclusion Criteria Prior treatment with conservative management or open surgery. Presence of multi-segmental (≥ 2 levels) lumbar disc herniation. Coexisting lumbar spondylolisthesis or spinal instability requiring fusion surgery. Presence of lumbar spinal infections, spinal tuberculosis, or tumors. Severe cardiopulmonary dysfunction. Study Design and Methodology Patients were stratified into groups according to their respective surgical approaches. All procedures were performed by highly experienced senior attending surgeons with the rank of associate chief physician or higher. Fifty-two patients undergoing unilateral biportal endoscopic discectomy were assigned to the UBED group, while sixty-five patients undergoing percutaneous endoscopic interlaminar discectomy were assigned to the PEID group. Comparative analyses were performed on the following parameters: operative time, intraoperative blood loss, incidence of complications, and frequency of intraoperative X-ray exposures. The Visual Analog Scale (VAS) scores and Oswestry Disability Index (ODI) scores were evaluated at three time points: preoperatively, 1 month postoperatively, and 6 months postoperatively. Additionally, changes in the cross-sectional area of the dural sac were compared between the two groups at preoperative and 1-month postoperative intervals. Surgical Techniques UBED Group Patients in this group underwent unilateral biportal endoscopic discectomy. Preoperatively, the affected spinal segment was identified based on imaging findings and the patient’s clinical symptoms and signs. The procedure was conducted under general anesthesia. Using a patient with left-sided L4/5 pathology as an example, after the induction of general anesthesia, the patient was placed in the prone position. The L4/5 intervertebral space was adjusted to align perpendicularly with the floor. Under fluoroscopic guidance, a horizontal line was drawn at the junction of the L4 spinous process and lamina, and a vertical line was drawn along the medial borders of the L4 and L5 pedicles on the left side. The intersection of these lines served as the reference point, with the observation and working channels established 1.5 cm above and below this point, respectively. Surgical incisions were made according to the diameter of the third-level dilator. Guide rods for both channels were inserted to the junction of the left spinous process and lamina and then converged. The incisions were progressively dilated, and the endoscope was introduced through the observation channel to provide visualization. A radiofrequency probe was inserted through the working channel to clear local soft tissues. After exposing the inferior edge of the L4 lamina, a burr and laminectomy rongeurs were utilized to prepare the bone surface, exposing the proximal insertion of the ligamentum flavum. The medial portion of the inferior L4 facet joint (approximately 4 mm) was further resected to expose the medial aspect of the L5 superior articular process and the L5 superior lamina. Following partial bone removal, the distal insertion of the ligamentum flavum was exposed, and the ligamentum flavum was excised to reveal the dura mater and the left L5 nerve root. A retractor was employed to gently retract the nerve root, and the herniated disc and nucleus pulposus were removed. After confirming adequate nerve root decompression and pulsation, a drainage tube was placed through the distal incision, and the procedure was concluded. Patients were encouraged to walk with lumbar support starting on the second postoperative day and were discharged within 4–5 days, followed by scheduled follow-ups for exercise guidance. PEID Group Patients in this group underwent percutaneous endoscopic interlaminar discectomy. Preoperatively, the affected spinal segment was determined based on imaging findings and the patient’s clinical symptoms and signs. The procedure was performed under general anesthesia. Using a patient with left-sided L4/5 pathology as an example, after the induction of general anesthesia, the patient was positioned prone with the abdomen suspended using a positioning pad. Under fluoroscopic guidance, the left L4/5 facet joint was identified as the initial landmark. A 1 cm skin incision was made, and a series of dilators were inserted, followed by the placement of the working cannula. After confirming the correct position under fluoroscopy, the spinal endoscope was introduced. A radiofrequency probe was used to clear soft tissues and achieve hemostasis. After exposing the bone surface, a visualized trephine was employed to remove bone, exposing the underlying ligamentum flavum. The ligamentum flavum was then excised using laminectomy rongeurs to reveal the dura mater and nerve root. By rotating the working cannula, the nerve root was gently retracted laterally to expose and remove the herniated disc and nucleus pulposus beneath the nerve root. After thorough removal, the radiofrequency probe was utilized to shrink the annulus fibrosus to reduce the risk of recurrence. The procedure was concluded after confirming adequate nerve root pulsation and decompression. Postoperative management was identical to that of the UBED group. Statistical Analysis Statistical analysis was performed using SPSS 23.0. All measured data were tested for normality, and the results were expressed as mean ± standard deviation. For continuous variables conforming to a normal distribution, the t-test was applied. The Mann-Whitney U test was used to compare two independent variables that did not follow a normal distribution. Categorical data were presented as [n (%)] and analyzed using the chi-square test. A P-value of < 0.05 was considered statistically significant. Results Comparison of Baseline Characteristics Between the Two Groups No statistically significant differences were observed between the two groups in terms of baseline characteristics, including age, gender, disease duration, lower limb symptoms, and affected spinal segments (P > 0.05). Detailed data are presented in Table 1 . Table 1 Comparison of Baseline Characteristics Between the Two Groups Analyzing factors UBED group (n = 52) PEID group (n = 65) t/χ 2 P Age (yr) 52.42 ± 14.31 56.40 ± 15.23 1.441 0.152 Gender (M/F) 26/26 30/35 0.171 0.679 Duration of disease(months) 16.69 ± 8.62 18.14 ± 9.08 0.875 0.383 Unilateral/Bilateral symptoms 37/15 46/19 0.002 0.964 Surgical segment L3/4 6 9 0.687 0.493 L4/5 21 29 L5/S1 25 27 Comparison of Perioperative Outcomes Between the Two Groups No statistically significant differences were observed in the total operative time between the two groups ( P > 0.05). However, subgroup analysis revealed that while the operative time for unilateral decompression was comparable between the two groups ( P > 0.05), the UBED group demonstrated a significantly shorter operative time than the PEID group for bilateral decompression ( P 0.05). Regarding complications, in the UBED group, one patient experienced symptom exacerbation postoperatively, and two patients reported sacrococcygeal pain during activity. In the PEID group, one patient sustained an intraoperative dural tear, resulting in postoperative cerebrospinal fluid leakage. Additionally, two patients experienced recurrence and worsening of lower limb symptoms within four weeks postoperatively, necessitating revision surgery. Two other patients with postoperative recurrence showed improvement following conservative management. No statistically significant differences were observed in the overall complication rates between the two groups ( P > 0.05). The average hospitalization cost in the UBED group was significantly higher than that in the PEID group (USD 3491.08 ± 83.68 vs. USD 1575.11 ± 159.08, P < 0.05). Table 2 Comparison of Perioperative Outcomes Between the Two Groups Analysis indicators UBED group PEID group t/χ 2 P Surgical Time (min) 90.81 ± 19.52 93.60 ± 26.21 0.660 0.511 Unilateral Decompression Surgical Time (min) 81.54 ± 10.82 78.17 ± 8.73 1.570 0.121 Bilateral Decompression Surgical Time (min) 113.67 ± 17.32 130.95 ± 13.12 3.313 0.002 Blood Loss (ml) 70.50 ± 16.53 71.74 ± 17.99 0.384 0.702 Complications [n (%)] 3(5.77%) 5(7.69%) 0.168 0.682 X-ray Exposure Times (times) 5.31 ± 1.70 5.23 ± 1.77 0.238 0.812 Length of Hospital Stay (days) 6.96 ± 1.60 6.66 ± 1.38 1.088 0.279 Total Hospital Cost ( $ ) 3491.08 ± 83.68 1575.11 ± 159.08 83.700 0.000 Efficacy Outcomes Between the Two Groups Postoperative VAS scores were significantly lower than preoperative scores in both groups ( P < 0.05). Similarly, the ODI scores showed significant improvement postoperatively ( P < 0.05), and the cross-sectional area of the dural sac was significantly larger after surgery compared to preoperative measurements ( P 0.05). However, the postoperative cross-sectional area of the dural sac in the UBED group was significantly greater than that in the PEID group ( P < 0.05). Table 3 Efficacy Outcomes Between the Two Groups UBED group PEID group t P VAS score (points) Before surgery 7.96 ± 1.05 8.03 ± 0.95 0.374 0.709 1 month after surgery 5.44 ± 0.83* 5.55 ± 0.95* 0.667 0.506 6 months after surgery 1.96 ± 0.91* # 1.98 ± 0.86* # 0.141 0.888 ODI index (%) Before surgery 70.08 ± 7.51 68.40 ± 7.83 1.172 0.244 1 month after surgery 44.92 ± 9.28* 44.00 ± 9.18* 0.538 0.592 6 months after surgery 27.12 ± 8.73* # 24.55 ± 9.25* # 1.526 0.130 Cross-sectional area of the dural sac (mm²) Before surgery 61.52 ± 6.35 62.74 ± 6.28 1.038 0.301 After surgery 116.79 ± 13.48* 105.85 ± 11.51* 4.734 0.000 Note: *P < 0.05 indicates a significant difference compared with the preoperative values; #P < 0.05 indicates a significant difference compared with the values 1 month after surgery. Discussion PEID was first introduced by Professor Ruetten in Germany in 2005. The posterior approach aligns more closely with the operational preferences of spine surgeons, offering straightforward localization and manipulation. It provides clear visualization of the ligamentum flavum, dura mater, and nerve roots while preserving spinal stability [ 7 – 9 ]. By rotating the working cannula, PEID allows the nerve root or dura to be gently retracted, enabling clear exposure of the herniated tissue and achieving effective spinal canal decompression. Numerous studies have demonstrated that PEID and open surgery exhibit comparable efficacy and safety in treating LDH. However, PEID offers distinct advantages, including smaller incisions, minimal disruption to surrounding muscles, and faster postoperative recovery [ 10 – 12 ]. In 2017, UBED emerged in South Korea and rapidly gained popularity in China two years later. UBED is characterized by the following features: (1) It utilizes two separate incisions for the observation and working channels, allowing bimanual operation without interference, thereby enhancing procedural efficiency; (2) The use of a water medium reduces intraoperative bleeding and improves visual clarity through hydrostatic pressure; (3) It aligns with the principles of open surgery but in a minimally invasive, endoscopic format, resulting in a shorter learning curve; (4) It provides a larger operating space and broader indications, enabling the management of more complex cases [ 13 – 17 ]. In cases of severe spinal stenosis, UBED facilitates clear exposure of the proximal and distal insertions of the ligamentum flavum, allowing for its en bloc removal. For simple disc herniation, the "target technique" can be employed to partially remove the ligamentum flavum above the site of neural compression, retract the nerve root, and excise the herniated disc tissue, minimizing disruption to spinal stability. In recent years, the debate between these two techniques has become a focal point. Generally, scholars tend to favor the technique they are more familiar with while remaining cautious about the other. Whether it is spinal endoscopy, UBED, or other techniques such as minimally invasive microscopy, these are merely tools designed to remove herniated disc tissue compressing the nerves and achieve effective decompression. A growing body of research indicates that both UBED and PEID yield favorable outcomes in treating LDH [ 18 – 23 ]. A retrospective analysis by Jianjian Yin on patients with L5/S1 disc herniation treated with spinal endoscopy found that UBED and PEID exhibited similar short-term efficacy for this segment [ 24 ]. In our study, both groups demonstrated significant reductions in VAS scores, improvements in the ODI, and increased cross-sectional areas of the dural sac postoperatively. These findings confirm that both techniques effectively remove herniated nucleus pulposus and achieve decompression. Notably, the UBED group exhibited a larger postoperative dural sac cross-sectional area compared to the PEID group, suggesting more thorough decompression, likely due to UBED’s larger operating space and more comprehensive tissue management. In our study, no significant difference in operative time was observed between UBED and PEID for unilateral decompression, indicating comparable efficiency for simpler unilateral cases. PEID’s direct interlaminar approach allows rapid localization and manipulation of unilateral herniations, while UBED’s dual-channel design, despite its larger operating space, requires initial space establishment and bone removal, negating any time advantage in unilateral cases. For bilateral decompression (ULBD), UBED had significantly shorter operative times than PEID, emphasizing its advantages in complex cases. UBED’s dual-channel system provides greater maneuverability and angles, and its protective burr sheath minimizes the risk of dural injury during contralateral manipulation. Additionally, UBED emphasizes preserving the ligamentum flavum until contralateral bone work is completed, as it protects the dura and nerve roots. In contrast, PEID’s single-channel design may limit its efficiency in bilateral cases, requiring more intricate maneuvers and time. No significant differences were observed between the two groups in intraoperative blood loss, hospital stay, or the number of intraoperative X-ray exposures, reflecting their shared minimally invasive and safe nature. Both UBED and PEID utilize endoscopic techniques for precise lesion localization and minimal tissue disruption, effectively controlling intraoperative bleeding. One study comparing blood loss found that PEID had significantly lower hidden blood loss than UBED, possibly due to less bone disruption [ 25 ]. Early ambulation with lumbar support on the second postoperative day contributed to similar hospital stays. In both techniques, preoperative fluoroscopy is primarily used for incision localization. With proficiency, UBED typically requires one additional fluoroscopy after soft tissue clearance and anchor point establishment, while PEID requires one after cannula insertion. Further fluoroscopy is rarely needed unless severe osteophytes or anatomical variations complicate the procedure. Regarding perioperative complications, a two-year follow-up study on PEID patients reported a reoperation rate of 6.2%, primarily due to recurrence, infection, or persistent low back pain [ 26 ]. In our study, one UBED patient experienced symptom exacerbation postoperatively, likely due to deep drain tube placement compressing the dura or nerve root, which resolved after tube removal. Two other UBED patients reported sacrococcygeal pain during activity, which improved after 4–6 weeks of conservative treatment, possibly due to excessive bone removal and local instability. In the PEID group, one patient sustained an intraoperative dural tear with postoperative cerebrospinal fluid leakage. Two patients required revision surgery within four weeks due to recurrent symptoms caused by residual herniated disc tissue. Two other PEID patients experienced recurrence but improved with conservative management. In terms of hospitalization costs, UBED was more expensive than PEID, primarily due to higher consumable costs, such as endoscopic burrs, radiofrequency probes, and plasma knives. Conclusion Both UBED and PEID are effective treatments for LDH. For patients with unilateral symptoms requiring unilateral decompression, the two techniques yield comparable outcomes, but PEID is more cost-effective. For patients with bilateral symptoms or bony spinal stenosis, UBED offers shorter operative times and better postoperative results. However, our study’s relatively small sample size necessitates further research with larger cohorts and extended follow-up to evaluate the long-term impact on spinal stability and function, providing more comprehensive guidance for clinical practice. Abbreviations UBE Unilateral Biportal Endoscopy PEID Percutaneous Endoscopic Interlaminar Discectomy VAS Visual Analog Scale ODI Oswestry Disability Index LDH Lumbar Disc Herniation Declarations Funding No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article. This work was supported by Weifang Young Medical Talent Support Project (WWZ2024113) and Weifang Municipal Health Commission Scientific Research Fund Project (WFWSJK-2024-008). Author Contribution Conception and design: L.CZ ,Z.W and W.T.Acquisition of data: L.CZ ,Z.W ,R.CH and W.T.Analysis and interpretation of data: L.CZ ,Z.W and W.T. Drafting the article: L.CZ, J.BX Critically revising the article: Z.W, WT and J.BX. Reviewed submitted version of manuscript: Z.W, WT and J.BX. Approved the final version of the manuscript on behalf of all authors: L.CZ. Statistical analysis: Z.CY and S.F. Administrative/technical/material support: L.CZ , Z.CY and S.F. Study supervision: Z.CY and S.F. Corresponding author:W.T References Yang, Y. F. et al. Comparison of clinical outcomes and cost-utility between unilateral biportal endoscopic discectomy and percutaneous endoscopic interlaminar discectomy for single-level lumbar disc herniation: a retrospective matched controlled study. J. Orthop. 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Unilateral Biportal Endoscopic Discectomy versus Percutaneous Endoscopic Lumbar Discectomy in the Treatment of Lumbar Disc Herniation Linked with Posterior Ring Apophysis Separation: A Retrospective Study. World neurosurgery, S1878-8750(24)01651-6. Advance online publication. (2024). https://doi.org/10.1016/j.wneu.2024.09.102 Wu, S., Zhong, D., Zhao, G., Liu, Y. & Wang, Y. Comparison of clinical outcomes between unilateral biportal endoscopic discectomy and percutaneous endoscopic interlaminar discectomy for migrated lumbar disc herniation at lower lumbar spine: a retrospective controlled study. J. Orthop. Surg, Res. 19 (1), 21. https://doi.org/10.1186/s13018-023-04484-z (2024). Yin, J., Gao, G., Chen, S., Ma, T. & Nong, L. Comparative study between unilateral biportal endoscopic discectomy and percutaneous interlaminar endoscopic discectomy for the treatment of L5/S1 disc herniation. World neurosurgery, S1878-8750(24)01973-9. Advance online publication. (2024). https://doi.org/10.1016/j.wneu.2024.11.109 Zhou, S. et al. Comparison of surgical invasiveness and hidden blood loss between unilateral double portal endoscopic lumbar disc extraction and percutaneous endoscopic interlaminar discectomy for lumbar spinal stenosis. J. Orthop. Surg, Res. 19 (1), 778. https://doi.org/10.1186/s13018-024-05274-x (2024). Tang, T. et al. Risk Factors and Causes of Reoperation in Lumbar Disc Herniation Patients after Percutaneous Endoscopic Lumbar Discectomy: A Retrospective Case Series with a Minimum 2-Year Follow-Up. Med. Sci. monitor: Int. Med. J. experimental Clin. Res. 29 , e939844. https://doi.org/10.12659/MSM.939844 (2023). Additional Declarations No competing interests reported. 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Hospital","correspondingAuthor":false,"prefix":"","firstName":"wei","middleName":"","lastName":"zhang","suffix":""},{"id":435922180,"identity":"dd5b8c5d-9358-4f10-94f6-f0bdb53dac2f","order_by":2,"name":"Cheng-Yue Zhu","email":"","orcid":"","institution":"Dingqiao Branch of Hangzhou Traditional Chinese Medicine Hospital","correspondingAuthor":false,"prefix":"","firstName":"Cheng-Yue","middleName":"","lastName":"Zhu","suffix":""},{"id":435922181,"identity":"7ae1bcf5-c54a-4b7b-824f-8feb9bf5b85c","order_by":3,"name":"Feng Shen","email":"","orcid":"","institution":"Pingdu Campus of Qingdao University Affiliated Hospital","correspondingAuthor":false,"prefix":"","firstName":"Feng","middleName":"","lastName":"Shen","suffix":""},{"id":435922182,"identity":"508fd590-6e5d-4313-85b4-abb7ada67555","order_by":4,"name":"Bao-Xin jia","email":"","orcid":"","institution":"Linqu County People's Hospital","correspondingAuthor":false,"prefix":"","firstName":"Bao-Xin","middleName":"","lastName":"jia","suffix":""},{"id":435922183,"identity":"620ec0f0-5aae-4edd-944b-5ee2c3e176d7","order_by":5,"name":"Cong-Hui Ren","email":"","orcid":"","institution":"Linqu County People's Hospital","correspondingAuthor":false,"prefix":"","firstName":"Cong-Hui","middleName":"","lastName":"Ren","suffix":""},{"id":435922184,"identity":"9923c9ab-e2a7-44bd-9736-1fc3b4139749","order_by":6,"name":"Ting Wang","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAr0lEQVRIiWNgGAWjYFAC5gaGBAMbHn72BqK1MDYwfKhIk5HsOUCCFsYZZw7bGNxwIFKDuXRj42PetvM8DDcYGD98zCFCi+Wcg83GvG23eRhnNzBLztxGhBaDG4lt0iAtzDIH2Jh5idTS/pu37RwPm0QC8VragN4/wMNDtBaQXyQ+VCTzSPAcbCbOL+bSzQc/JBjY2dsfBzI+EuUwCTgTGKdEASQto2AUjIJRMApwAAAB7Del+SJpNQAAAABJRU5ErkJggg==","orcid":"","institution":"Pingdu Campus of Qingdao University Affiliated Hospital","correspondingAuthor":true,"prefix":"","firstName":"Ting","middleName":"","lastName":"Wang","suffix":""}],"badges":[],"createdAt":"2025-03-30 13:08:15","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6338564/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6338564/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":79766283,"identity":"585df734-ac8f-443f-8ad2-08548b229945","added_by":"auto","created_at":"2025-04-02 12:21:18","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":1055790,"visible":true,"origin":"","legend":"\u003cp\u003eFigure 1 Schematic Diagram of the UBED Procedure 1-a: A horizontal line is drawn at the junction of the spinous process and lamina.1-b: A vertical line is drawn along the medial border of the pedicle.1-c: The initial convergence point of the instruments and endoscope.1-d: Exposure of the proximal insertion of the ligamentum flavum.1-e: Exposure of the distal insertion of the ligamentum flavum.1-f: Visualization of the nerve root and dura mater.1-g: Exposure of the herniated disc after retraction of the nerve root.1-h: Post-discectomy view after removal of the herniated disc.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-6338564/v1/fdd8ce868d5a4a6a31054984.png"},{"id":79766284,"identity":"221c379a-bcac-48d4-a965-b76822a4e548","added_by":"auto","created_at":"2025-04-02 12:21:18","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":1042891,"visible":true,"origin":"","legend":"\u003cp\u003eSchematic Diagram of the PEID Procedure 2-a: Preoperative marking of the incision site.2-b: Confirmation of the working cannula position after insertion.2-c: Incision of the ligamentum flavum to expose the nerve root.2-d: Retraction of the nerve root using the working cannula to expose the underlying disc tissue.2-e: Removal of the herniated disc tissue.2-f: Decompressed nerve root and dura mater.\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-6338564/v1/6dd9ed66bc1b37081d5e6d04.png"},{"id":79765875,"identity":"44d2a82c-fc3a-4466-9dde-bf1303f4a3a1","added_by":"auto","created_at":"2025-04-02 12:13:18","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":966299,"visible":true,"origin":"","legend":"\u003cp\u003eOperative Diagrams of the Two Surgical Approaches\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-6338564/v1/79a748d112caefcfb8d253e9.png"},{"id":81676938,"identity":"02357da6-e7de-448c-8742-32ebe796fa72","added_by":"auto","created_at":"2025-04-30 07:46:48","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":4990217,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6338564/v1/c953b33f-1b40-4701-bf68-b0c0f9a38b89.pdf"},{"id":79765874,"identity":"decb532b-7101-405d-8e76-02a9c2ce4fb6","added_by":"auto","created_at":"2025-04-02 12:13:18","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":18133,"visible":true,"origin":"","legend":"","description":"","filename":"supplementaryfile.docx","url":"https://assets-eu.researchsquare.com/files/rs-6338564/v1/e20c07c7b3a65e47c17326e3.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Comparison of the therapeutic effects of unilateral biportal endoscopic discectomy and percutaneous endoscopic interlaminar discectomy in the treatment of lumbar disc herniation","fulltext":[{"header":"Introduction","content":"\u003cp\u003eLumbar disc herniation is a common and frequently encountered condition in spinal surgery, primarily presenting with low back pain accompanied by radiating pain and numbness in the lower extremities. While the majority of lumbar disc herniation cases improve with conservative management, a subset of patients still require surgical intervention. In recent years, with ongoing advancements in medical technology, spinal endoscopy has emerged as a widely utilized and promising technique for the treatment of lumbar disc herniation. Both Unilateral Biportal Endoscopy (UBE) and Percutaneous Endoscopic Interlaminar Discectomy (PEID) have demonstrated favorable outcomes in treating this condition [\u003cspan additionalcitationids=\"CR2\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. The development of fully visualized endoscopic techniques, along with the Endo-Surg concept that incorporates an open-surgery-like perspective into endoscopic procedures, has significantly improved the precision of spinal endoscopy. Surgeons can now operate in a highly visualized field, similar to open surgery, allowing for accurate identification of spinal structures and minimizing the risk of inadvertent damage to surrounding healthy tissues.\u003c/p\u003e \u003cp\u003eUBE has experienced remarkable development in recent years, with the technique becoming increasingly refined and its indications expanding [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Compared to single-channel endoscopy, dual-channel technology provides a larger operative space, clearer visualization, and separation of the observation and operative channels, thus making the procedure more efficient, flexible, and easier to perform [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Although both techniques have shown promising results, there is a limited body of comparative research on UBE and PEID for the treatment of lumbar disc herniation. This study aims to conduct a comparative analysis of the clinical efficacy of UBE and PEID in treating lumbar disc herniation, with the objective of optimizing treatment strategies and enhancing patient outcomes and prognosis.\u003c/p\u003e"},{"header":"Materials and methods","content":"\u003cp\u003eA total of 117 patients diagnosed with lumbar disc herniation were enrolled in this study from three spine centers at Linqu County People's Hospital, Hangzhou Traditional Chinese Medicine Hospital, and Qingdao University Affiliated Hospital between April 2023 and March 2024. Among them, 56 were male and 61 were female, with ages ranging from 18 to 83 years (mean age: 54.63\u0026thinsp;\u0026plusmn;\u0026thinsp;14.90 years). The distribution of affected segments was as follows: 15 cases involved the L3/4 segment, 50 cases the L4/5 segment, and 52 cases the L5/S1 segment. Clinically, 83 patients presented with unilateral lower limb symptoms, while 34 exhibited symptoms in both lower limbs. All patients provided written informed consent, and the study was approved by the institutional ethics committees of the respective hospitals.\u003c/p\u003e\n\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\n\u003ch2\u003eInclusion and exclusion criteria\u003c/h2\u003e\n\u003cp\u003e\u003cstrong\u003eInclusion criteria\u003c/strong\u003e\u003c/p\u003e\n\u003col\u003e\n\u003cli\u003e\n\u003cp\u003eAll patients met the diagnostic criteria for lumbar disc herniation [\u003cspan class=\"CitationRef\"\u003e6\u003c/span\u003e], exhibiting typical clinical manifestations such as unilateral or bilateral lower limb pain and numbness, which were consistent with imaging findings.\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003eThe lesions were confined to a single spinal level.\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003eComplete clinical data were available for all patients.\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003ePrior to admission, patients had undergone conservative treatment for a minimum of three months, with no significant improvement or worsening of symptoms.\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003eAll patients underwent either unilateral biportal endoscopic spinal surgery or percutaneous interlaminar endoscopic spinal surgery following comprehensive preoperative evaluations.\u003c/p\u003e\n\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003e\u003cstrong\u003eExclusion Criteria\u003c/strong\u003e\u003c/p\u003e\n\u003col\u003e\n\u003cli\u003e\n\u003cp\u003ePrior treatment with conservative management or open surgery.\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003ePresence of multi-segmental (\u0026ge;\u0026thinsp;2 levels) lumbar disc herniation.\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003eCoexisting lumbar spondylolisthesis or spinal instability requiring fusion surgery.\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003ePresence of lumbar spinal infections, spinal tuberculosis, or tumors.\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003eSevere cardiopulmonary dysfunction.\u003c/p\u003e\n\u003c/li\u003e\n\u003c/ol\u003e\n\u003c/div\u003e\n\u003ch3\u003eStudy Design and Methodology\u003c/h3\u003e\n\u003cp\u003ePatients were stratified into groups according to their respective surgical approaches. All procedures were performed by highly experienced senior attending surgeons with the rank of associate chief physician or higher. Fifty-two patients undergoing unilateral biportal endoscopic discectomy were assigned to the UBED group, while sixty-five patients undergoing percutaneous endoscopic interlaminar discectomy were assigned to the PEID group. Comparative analyses were performed on the following parameters: operative time, intraoperative blood loss, incidence of complications, and frequency of intraoperative X-ray exposures. The Visual Analog Scale (VAS) scores and Oswestry Disability Index (ODI) scores were evaluated at three time points: preoperatively, 1 month postoperatively, and 6 months postoperatively. Additionally, changes in the cross-sectional area of the dural sac were compared between the two groups at preoperative and 1-month postoperative intervals.\u003c/p\u003e\n\u003ch3\u003eSurgical Techniques\u003c/h3\u003e\n\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e\n\u003ch2\u003eUBED Group\u003c/h2\u003e\n\u003cp\u003ePatients in this group underwent unilateral biportal endoscopic discectomy. Preoperatively, the affected spinal segment was identified based on imaging findings and the patient\u0026rsquo;s clinical symptoms and signs. The procedure was conducted under general anesthesia. Using a patient with left-sided L4/5 pathology as an example, after the induction of general anesthesia, the patient was placed in the prone position. The L4/5 intervertebral space was adjusted to align perpendicularly with the floor. Under fluoroscopic guidance, a horizontal line was drawn at the junction of the L4 spinous process and lamina, and a vertical line was drawn along the medial borders of the L4 and L5 pedicles on the left side. The intersection of these lines served as the reference point, with the observation and working channels established 1.5 cm above and below this point, respectively. Surgical incisions were made according to the diameter of the third-level dilator. Guide rods for both channels were inserted to the junction of the left spinous process and lamina and then converged. The incisions were progressively dilated, and the endoscope was introduced through the observation channel to provide visualization. A radiofrequency probe was inserted through the working channel to clear local soft tissues. After exposing the inferior edge of the L4 lamina, a burr and laminectomy rongeurs were utilized to prepare the bone surface, exposing the proximal insertion of the ligamentum flavum. The medial portion of the inferior L4 facet joint (approximately 4 mm) was further resected to expose the medial aspect of the L5 superior articular process and the L5 superior lamina. Following partial bone removal, the distal insertion of the ligamentum flavum was exposed, and the ligamentum flavum was excised to reveal the dura mater and the left L5 nerve root. A retractor was employed to gently retract the nerve root, and the herniated disc and nucleus pulposus were removed. After confirming adequate nerve root decompression and pulsation, a drainage tube was placed through the distal incision, and the procedure was concluded. Patients were encouraged to walk with lumbar support starting on the second postoperative day and were discharged within 4\u0026ndash;5 days, followed by scheduled follow-ups for exercise guidance.\u003c/p\u003e\n\u003c/div\u003e\n\u003ch3\u003ePEID Group\u003c/h3\u003e\n\u003cp\u003ePatients in this group underwent percutaneous endoscopic interlaminar discectomy. Preoperatively, the affected spinal segment was determined based on imaging findings and the patient\u0026rsquo;s clinical symptoms and signs. The procedure was performed under general anesthesia. Using a patient with left-sided L4/5 pathology as an example, after the induction of general anesthesia, the patient was positioned prone with the abdomen suspended using a positioning pad. Under fluoroscopic guidance, the left L4/5 facet joint was identified as the initial landmark. A 1 cm skin incision was made, and a series of dilators were inserted, followed by the placement of the working cannula. After confirming the correct position under fluoroscopy, the spinal endoscope was introduced. A radiofrequency probe was used to clear soft tissues and achieve hemostasis. After exposing the bone surface, a visualized trephine was employed to remove bone, exposing the underlying ligamentum flavum. The ligamentum flavum was then excised using laminectomy rongeurs to reveal the dura mater and nerve root. By rotating the working cannula, the nerve root was gently retracted laterally to expose and remove the herniated disc and nucleus pulposus beneath the nerve root. After thorough removal, the radiofrequency probe was utilized to shrink the annulus fibrosus to reduce the risk of recurrence. The procedure was concluded after confirming adequate nerve root pulsation and decompression. Postoperative management was identical to that of the UBED group.\u003c/p\u003e\n\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\n\u003ch2\u003eStatistical Analysis\u003c/h2\u003e\n\u003cp\u003eStatistical analysis was performed using SPSS 23.0. All measured data were tested for normality, and the results were expressed as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation. For continuous variables conforming to a normal distribution, the t-test was applied. The Mann-Whitney U test was used to compare two independent variables that did not follow a normal distribution. Categorical data were presented as [n (%)] and analyzed using the chi-square test. A P-value of \u0026lt;\u0026thinsp;0.05 was considered statistically significant.\u003c/p\u003e\n\u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003eComparison of Baseline Characteristics Between the Two Groups\u003c/h2\u003e \u003cp\u003eNo statistically significant differences were observed between the two groups in terms of baseline characteristics, including age, gender, disease duration, lower limb symptoms, and affected spinal segments (P\u0026thinsp;\u0026gt;\u0026thinsp;0.05). Detailed data are presented in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of Baseline Characteristics Between the Two Groups\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAnalyzing factors\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUBED group\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;52)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePEID group\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;65)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003et/χ\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge (yr)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e52.42\u0026thinsp;\u0026plusmn;\u0026thinsp;14.31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e56.40\u0026thinsp;\u0026plusmn;\u0026thinsp;15.23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.441\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.152\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender (M/F)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e26/26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e30/35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.171\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.679\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDuration of disease(months)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16.69\u0026thinsp;\u0026plusmn;\u0026thinsp;8.62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18.14\u0026thinsp;\u0026plusmn;\u0026thinsp;9.08\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.875\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.383\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnilateral/Bilateral symptoms\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e37/15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e46/19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.002\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.964\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSurgical segment\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\u003eL3/4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.687\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.493\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eL4/5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e29\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=\"left\" colname=\"c2\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e27\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eComparison of Perioperative Outcomes Between the Two Groups\u003c/h2\u003e \u003cp\u003eNo statistically significant differences were observed in the total operative time between the two groups (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05). However, subgroup analysis revealed that while the operative time for unilateral decompression was comparable between the two groups (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05), the UBED group demonstrated a significantly shorter operative time than the PEID group for bilateral decompression (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05). No significant differences were noted between the two groups in terms of intraoperative blood loss, length of hospital stay, or the number of intraoperative X-ray exposures (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05).\u003c/p\u003e \u003cp\u003eRegarding complications, in the UBED group, one patient experienced symptom exacerbation postoperatively, and two patients reported sacrococcygeal pain during activity. In the PEID group, one patient sustained an intraoperative dural tear, resulting in postoperative cerebrospinal fluid leakage. Additionally, two patients experienced recurrence and worsening of lower limb symptoms within four weeks postoperatively, necessitating revision surgery. Two other patients with postoperative recurrence showed improvement following conservative management. No statistically significant differences were observed in the overall complication rates between the two groups (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05).\u003c/p\u003e \u003cp\u003eThe average hospitalization cost in the UBED group was significantly higher than that in the PEID group (USD 3491.08\u0026thinsp;\u0026plusmn;\u0026thinsp;83.68 vs. USD 1575.11\u0026thinsp;\u0026plusmn;\u0026thinsp;159.08, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of Perioperative Outcomes Between the Two Groups\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAnalysis indicators\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUBED group\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePEID group\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003et/χ\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSurgical Time (min)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e90.81\u0026thinsp;\u0026plusmn;\u0026thinsp;19.52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e93.60\u0026thinsp;\u0026plusmn;\u0026thinsp;26.21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.660\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.511\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnilateral Decompression Surgical Time (min)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e81.54\u0026thinsp;\u0026plusmn;\u0026thinsp;10.82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e78.17\u0026thinsp;\u0026plusmn;\u0026thinsp;8.73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.570\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.121\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBilateral Decompression Surgical Time (min)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e113.67\u0026thinsp;\u0026plusmn;\u0026thinsp;17.32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e130.95\u0026thinsp;\u0026plusmn;\u0026thinsp;13.12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.313\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.002\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBlood Loss (ml)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e70.50\u0026thinsp;\u0026plusmn;\u0026thinsp;16.53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e71.74\u0026thinsp;\u0026plusmn;\u0026thinsp;17.99\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.384\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.702\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eComplications [n (%)]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3(5.77%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5(7.69%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.168\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.682\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eX-ray Exposure Times (times)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5.31\u0026thinsp;\u0026plusmn;\u0026thinsp;1.70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.23\u0026thinsp;\u0026plusmn;\u0026thinsp;1.77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.238\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.812\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLength of Hospital Stay (days)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6.96\u0026thinsp;\u0026plusmn;\u0026thinsp;1.60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6.66\u0026thinsp;\u0026plusmn;\u0026thinsp;1.38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.088\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.279\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal Hospital Cost (\u003cspan\u003e$\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3491.08\u0026thinsp;\u0026plusmn;\u0026thinsp;83.68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1575.11\u0026thinsp;\u0026plusmn;\u0026thinsp;159.08\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e83.700\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eEfficacy Outcomes Between the Two Groups\u003c/h2\u003e \u003cp\u003ePostoperative VAS scores were significantly lower than preoperative scores in both groups (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Similarly, the ODI scores showed significant improvement postoperatively (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05), and the cross-sectional area of the dural sac was significantly larger after surgery compared to preoperative measurements (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05). When comparing the VAS and ODI scores between the two groups, no statistically significant differences were observed either preoperatively or postoperatively (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05). However, the postoperative cross-sectional area of the dural sac in the UBED group was significantly greater than that in the PEID group (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\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\u003eEfficacy Outcomes Between the Two Groups\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUBED group\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePEID group\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003et\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eVAS score (points)\u003c/b\u003e\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\u003eBefore surgery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7.96\u0026thinsp;\u0026plusmn;\u0026thinsp;1.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8.03\u0026thinsp;\u0026plusmn;\u0026thinsp;0.95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.374\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.709\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1 month after surgery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5.44\u0026thinsp;\u0026plusmn;\u0026thinsp;0.83*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.55\u0026thinsp;\u0026plusmn;\u0026thinsp;0.95*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.667\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.506\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6 months after surgery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.96\u0026thinsp;\u0026plusmn;\u0026thinsp;0.91*\u003csup\u003e#\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.98\u0026thinsp;\u0026plusmn;\u0026thinsp;0.86*\u003csup\u003e#\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.141\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.888\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eODI index (%)\u003c/b\u003e\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\u003eBefore surgery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e70.08\u0026thinsp;\u0026plusmn;\u0026thinsp;7.51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e68.40\u0026thinsp;\u0026plusmn;\u0026thinsp;7.83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.172\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.244\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1 month after surgery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e44.92\u0026thinsp;\u0026plusmn;\u0026thinsp;9.28*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e44.00\u0026thinsp;\u0026plusmn;\u0026thinsp;9.18*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.538\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.592\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6 months after surgery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e27.12\u0026thinsp;\u0026plusmn;\u0026thinsp;8.73*\u003csup\u003e#\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e24.55\u0026thinsp;\u0026plusmn;\u0026thinsp;9.25*\u003csup\u003e#\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.526\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.130\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCross-sectional area of the dural sac (mm\u0026sup2;)\u003c/b\u003e\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\u003eBefore surgery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e61.52\u0026thinsp;\u0026plusmn;\u0026thinsp;6.35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e62.74\u0026thinsp;\u0026plusmn;\u0026thinsp;6.28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.038\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.301\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAfter surgery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e116.79\u0026thinsp;\u0026plusmn;\u0026thinsp;13.48*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e105.85\u0026thinsp;\u0026plusmn;\u0026thinsp;11.51*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4.734\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eNote: \u003cem\u003e*P\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05 indicates a significant difference compared with the preoperative values; \u003cem\u003e#P\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05 indicates a significant difference compared with the values 1 month after surgery.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003ePEID was first introduced by Professor Ruetten in Germany in 2005. The posterior approach aligns more closely with the operational preferences of spine surgeons, offering straightforward localization and manipulation. It provides clear visualization of the ligamentum flavum, dura mater, and nerve roots while preserving spinal stability [\u003cspan additionalcitationids=\"CR8\" citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. By rotating the working cannula, PEID allows the nerve root or dura to be gently retracted, enabling clear exposure of the herniated tissue and achieving effective spinal canal decompression. Numerous studies have demonstrated that PEID and open surgery exhibit comparable efficacy and safety in treating LDH. However, PEID offers distinct advantages, including smaller incisions, minimal disruption to surrounding muscles, and faster postoperative recovery [\u003cspan additionalcitationids=\"CR11\" citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn 2017, UBED emerged in South Korea and rapidly gained popularity in China two years later. UBED is characterized by the following features: (1) It utilizes two separate incisions for the observation and working channels, allowing bimanual operation without interference, thereby enhancing procedural efficiency; (2) The use of a water medium reduces intraoperative bleeding and improves visual clarity through hydrostatic pressure; (3) It aligns with the principles of open surgery but in a minimally invasive, endoscopic format, resulting in a shorter learning curve; (4) It provides a larger operating space and broader indications, enabling the management of more complex cases [\u003cspan additionalcitationids=\"CR14 CR15 CR16\" citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. In cases of severe spinal stenosis, UBED facilitates clear exposure of the proximal and distal insertions of the ligamentum flavum, allowing for its en bloc removal. For simple disc herniation, the \"target technique\" can be employed to partially remove the ligamentum flavum above the site of neural compression, retract the nerve root, and excise the herniated disc tissue, minimizing disruption to spinal stability.\u003c/p\u003e \u003cp\u003eIn recent years, the debate between these two techniques has become a focal point. Generally, scholars tend to favor the technique they are more familiar with while remaining cautious about the other. Whether it is spinal endoscopy, UBED, or other techniques such as minimally invasive microscopy, these are merely tools designed to remove herniated disc tissue compressing the nerves and achieve effective decompression. A growing body of research indicates that both UBED and PEID yield favorable outcomes in treating LDH [\u003cspan additionalcitationids=\"CR19 CR20 CR21 CR22\" citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. A retrospective analysis by Jianjian Yin on patients with L5/S1 disc herniation treated with spinal endoscopy found that UBED and PEID exhibited similar short-term efficacy for this segment [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. In our study, both groups demonstrated significant reductions in VAS scores, improvements in the ODI, and increased cross-sectional areas of the dural sac postoperatively. These findings confirm that both techniques effectively remove herniated nucleus pulposus and achieve decompression. Notably, the UBED group exhibited a larger postoperative dural sac cross-sectional area compared to the PEID group, suggesting more thorough decompression, likely due to UBED\u0026rsquo;s larger operating space and more comprehensive tissue management.\u003c/p\u003e \u003cp\u003eIn our study, no significant difference in operative time was observed between UBED and PEID for unilateral decompression, indicating comparable efficiency for simpler unilateral cases. PEID\u0026rsquo;s direct interlaminar approach allows rapid localization and manipulation of unilateral herniations, while UBED\u0026rsquo;s dual-channel design, despite its larger operating space, requires initial space establishment and bone removal, negating any time advantage in unilateral cases. For bilateral decompression (ULBD), UBED had significantly shorter operative times than PEID, emphasizing its advantages in complex cases. UBED\u0026rsquo;s dual-channel system provides greater maneuverability and angles, and its protective burr sheath minimizes the risk of dural injury during contralateral manipulation. Additionally, UBED emphasizes preserving the ligamentum flavum until contralateral bone work is completed, as it protects the dura and nerve roots. In contrast, PEID\u0026rsquo;s single-channel design may limit its efficiency in bilateral cases, requiring more intricate maneuvers and time.\u003c/p\u003e \u003cp\u003eNo significant differences were observed between the two groups in intraoperative blood loss, hospital stay, or the number of intraoperative X-ray exposures, reflecting their shared minimally invasive and safe nature. Both UBED and PEID utilize endoscopic techniques for precise lesion localization and minimal tissue disruption, effectively controlling intraoperative bleeding. One study comparing blood loss found that PEID had significantly lower hidden blood loss than UBED, possibly due to less bone disruption [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. Early ambulation with lumbar support on the second postoperative day contributed to similar hospital stays. In both techniques, preoperative fluoroscopy is primarily used for incision localization. With proficiency, UBED typically requires one additional fluoroscopy after soft tissue clearance and anchor point establishment, while PEID requires one after cannula insertion. Further fluoroscopy is rarely needed unless severe osteophytes or anatomical variations complicate the procedure.\u003c/p\u003e \u003cp\u003eRegarding perioperative complications, a two-year follow-up study on PEID patients reported a reoperation rate of 6.2%, primarily due to recurrence, infection, or persistent low back pain [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. In our study, one UBED patient experienced symptom exacerbation postoperatively, likely due to deep drain tube placement compressing the dura or nerve root, which resolved after tube removal. Two other UBED patients reported sacrococcygeal pain during activity, which improved after 4\u0026ndash;6 weeks of conservative treatment, possibly due to excessive bone removal and local instability. In the PEID group, one patient sustained an intraoperative dural tear with postoperative cerebrospinal fluid leakage. Two patients required revision surgery within four weeks due to recurrent symptoms caused by residual herniated disc tissue. Two other PEID patients experienced recurrence but improved with conservative management. In terms of hospitalization costs, UBED was more expensive than PEID, primarily due to higher consumable costs, such as endoscopic burrs, radiofrequency probes, and plasma knives.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eBoth UBED and PEID are effective treatments for LDH. For patients with unilateral symptoms requiring unilateral decompression, the two techniques yield comparable outcomes, but PEID is more cost-effective. For patients with bilateral symptoms or bony spinal stenosis, UBED offers shorter operative times and better postoperative results. However, our study\u0026rsquo;s relatively small sample size necessitates further research with larger cohorts and extended follow-up to evaluate the long-term impact on spinal stability and function, providing more comprehensive guidance for clinical practice.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eUBE Unilateral Biportal Endoscopy\u003c/p\u003e\u003cp\u003ePEID Percutaneous Endoscopic Interlaminar Discectomy\u003c/p\u003e\u003cp\u003eVAS Visual Analog Scale\u003c/p\u003e\u003cp\u003eODI Oswestry Disability Index\u003c/p\u003e\u003cp\u003eLDH Lumbar Disc Herniation\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eFunding\u003c/h2\u003e \u003cp\u003eNo benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article. This work was supported by Weifang Young Medical Talent Support Project (WWZ2024113) and Weifang Municipal Health Commission Scientific Research Fund Project (WFWSJK-2024-008).\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eConception and design: L.CZ ,Z.W and W.T.Acquisition of data: L.CZ ,Z.W ,R.CH and W.T.Analysis and interpretation of data: L.CZ ,Z.W and W.T. Drafting the article: L.CZ, J.BX Critically revising the article: Z.W, WT and J.BX. Reviewed submitted version of manuscript: Z.W, WT and J.BX. Approved the final version of the manuscript on behalf of all authors: L.CZ. Statistical analysis: Z.CY and S.F. Administrative/technical/material support: L.CZ , Z.CY and S.F. Study supervision: Z.CY and S.F. Corresponding author:W.T\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eYang, Y. F. et al. 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Surg.\u003c/em\u003e \u003cb\u003e36\u003c/b\u003e (10), 1186\u0026ndash;1191. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.7507/1002-1892.202205095\u003c/span\u003e\u003cspan address=\"10.7507/1002-1892.202205095\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2022).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMa, X. et al. 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Res.\u003c/em\u003e \u003cb\u003e29\u003c/b\u003e, e939844. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.12659/MSM.939844\u003c/span\u003e\u003cspan address=\"10.12659/MSM.939844\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2023).\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":false,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"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":"Unilateral Biportal Endoscopy, Percutaneous Endoscopic Interlaminar discectomy, Lumbar Disc Herniation, Lumbar Spinal Stenosis","lastPublishedDoi":"10.21203/rs.3.rs-6338564/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6338564/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eObjectives\u003c/strong\u003e Over recent years, minimally invasive spine surgery has seen rapid advancement, with Unilateral Biportal Endoscopy (UBE) and Percutaneous Endoscopic Interlaminar Discectomy (PEID) emerging as increasingly important techniques for the treatment of lumbar disc herniation. The UBE technique involves the creation of two small incisions on one side of the patient's spine, offering flexibility and precision during surgery. In contrast, the PEID technique establishes a working channel through percutaneous puncture, performing the procedure under endoscopic visualization. Although both techniques are increasingly adopted, comparative studies remain limited. This study aims to compare the clinical efficacy of UBE and PEID in the management of lumbar disc herniation, with the goal of providing clinicians with more evidence-based treatment options.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods \u003c/strong\u003eA total of 117 patients diagnosed with lumbar disc herniation were treated at three spinal centers: Linqu County People's Hospital, Hangzhou Traditional Chinese Medicine Hospital, and Qingdao University Affiliated Hospital, between April 2023 and March 2024. Based on the surgical technique chosen, patients were divided into two groups: the UBE group (52 patients undergoing Unilateral Biportal Endoscopy) and the PEID group (65 patients undergoing Percutaneous Endoscopic Interlaminar Discectomy). Various surgical parameters, including operative time, blood loss, complication rates, X-ray exposure, and other clinical outcomes, were compared between the two groups. The Visual Analog Scale (VAS) and Oswestry Disability Index (ODI) scores were evaluated preoperatively, and at 1 and 6 months postoperatively. Additionally, the cross-sectional area of the dural sac was measured preoperatively and 1 month postoperatively.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e Baseline characteristics, including age, gender, and duration of symptoms, were comparable between the two groups (\u003cem\u003eP\u003c/em\u003e\u0026gt;0.05). For patients undergoing unilateral decompression, there was no significant difference in operative time between the two groups (\u003cem\u003eP\u003c/em\u003e\u0026gt;0.05). However, for patients requiring bilateral decompression, the UBE group demonstrated significantly shorter operative times compared to the PEID group (\u003cem\u003eP\u003c/em\u003e\u0026lt;0.05). Intraoperative blood loss, length of hospitalization, X-ray exposure, and complication rates did not differ significantly between the two groups (\u003cem\u003eP\u003c/em\u003e\u0026gt;0.05). Nevertheless, the UBE group incurred significantly higher hospitalization costs than the PEID group (\u003cem\u003eP\u003c/em\u003e\u0026lt;0.05). Postoperatively, both groups showed significant improvements in VAS scores (\u003cem\u003eP\u003c/em\u003e \u0026lt; 0.05) and ODI scores (\u003cem\u003eP\u003c/em\u003e\u0026lt;0.05), with a notable increase in the cross-sectional area of the dural sac (\u003cem\u003eP\u003c/em\u003e\u0026lt;0.05). Additionally, the UBE group exhibited a larger postoperative cross-sectional area of the dural sac compared to the PEID group (\u003cem\u003eP\u003c/em\u003e\u0026lt;0.05).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions\u003c/strong\u003e Both UBE and PEID are effective techniques for treating lumbar disc herniation. For patients with unilateral symptoms, both methods yield comparable outcomes, with PEID associated with lower hospitalization costs. For patients with bilateral symptoms, UBE offers a shorter operative time and superior postoperative outcomes.\u003c/p\u003e","manuscriptTitle":"Comparison of the therapeutic effects of unilateral biportal endoscopic discectomy and percutaneous endoscopic interlaminar discectomy in the treatment of lumbar disc herniation","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-04-02 12:13:13","doi":"10.21203/rs.3.rs-6338564/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":"5208f507-7955-457f-84a6-2f7ba8109918","owner":[],"postedDate":"April 2nd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":46413027,"name":"Health sciences/Medical research/Study design/Randomized controlled trials"},{"id":46413028,"name":"Health sciences/Health occupations/Orthopaedics"}],"tags":[],"updatedAt":"2025-04-30T07:38:36+00:00","versionOfRecord":[],"versionCreatedAt":"2025-04-02 12:13:13","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6338564","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6338564","identity":"rs-6338564","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}