Comparison of unilateral biportal and percutaneous endoscopic discectomy in treating far lateral lumbar disc herniation

OBJECTIVES: This study aims to investigate the clinical efficacy of managing far lateral lumbar disc herniation (FLLDH) through two surgical approaches: unilateral biportal endoscopy (UBE) and percutaneous endoscopic lumbar discectomy (PELD). PATIENTS AND METHODS: Between December 2019 and September 2024, a total of 45 patients (18 males, 27 females; mean age: 59.76±11.82 years; range, 31 to 89 years) who were diagnosed with FLLDH were retrospectively analyzed. Based on the surgical technique used, the patients were randomly divided into two groups: the PELD group (n=17) and the UBE group (n=28). Perioperative indicators, including operative time, postoperative hospital stay and mean fluoroscopy times, were recorded. Pre- and postoperative assessments were conducted at the time of admission and at one, three, and six months after surgery, using the Visual Analog Scale (VAS) and the Oswestry Disability Index (ODI) scores. The modified MacNab criteria were used to assess patient satisfaction. RESULTS: Both groups demonstrated a reduction in VAS and ODI scores after surgery (p<0.05). However, no statistically significant differences were observed between the groups at one, three, or six months postoperatively. Operative times were also comparable, with the UBE group mean 97.39±26.78 min and the PELD group 88.18±27.52 min. The postoperative length of hospital stay was similar, with the UBE group staying a mean of 3.93±1.81 days and the PELD group 3.06±1.21 days (p>0.05). The mean fluoroscopy times were significantly lower in the UBE group, with 6.25±1.30 times compared to 16.76±6.02 times in the PELD group (p<0.05). CONCLUSION: Our study results suggest that UBE is a viable alternative to PELD for treating FLLDH, offering comparable clinical outcomes with reduced radiation exposure.