Comparison of clinical efficacy of unilateral biportal endoscopic discectomy and percutaneous endoscopic interlaminar discectomy in the treatment of lumbar disc herniation at different segments

To compare outcomes of unilateral biportal endoscopic discectomy (UBED) and percutaneous endoscopic interlaminar discectomy (PEID) for lumbar disc herniation (LDH) at L3-S1 levels, aiming to identify the optimal segment-specific approach given anatomical variations between laminae. A retrospective analysis of 210 LDH patients was conducted (UBED: n = 102 [L3/4 = 22, L4/5 = 42, L5/S1 = 38]; PEID: n = 108 [L3/4 = 16, L4/5 = 47, L5/S1 = 45]). Both groups had a follow-up period of more than six months. Assessed parameters included: intraoperative blood loss, postoperative hemoglobin loss, surgical duration, incision length, drainage volume, hospital stay, costs, VAS (back/leg pain at 3d/1m/6m), ODI, and modified MacNab criteria. Both groups showed significant postoperative improvement in VAS and ODI scores. Overall, UBED had larger incisions, greater drainage volume, higher costs, and longer hospital stays than PEID. For L4/5 and L5/S1 LDH, UBED resulted in more intraoperative blood loss, greater hemoglobin loss, and longer surgical duration. Conversely, for L3/4 LDH, UBED had significantly shorter surgical time. No significant differences existed in 6-months postoperative complications or MacNab scores. UBED and PEID both achieve good clinical outcomes. PEID demonstrates significant advantages for L4/5 and L5/S1 LDH, offering less bleeding and shorter surgical time. UBED is advantageous for L3/4 LDH due to shorter surgical duration. PEID also allows omission of drainage tubes due to minimal postoperative drainage.