Impact of first ambulation time on unilateral biportal endoscopy in lumbar disc herniation: a systematic review and meta-analysis

Background: This study aimed to evaluate the effect of early versus late postoperative ambulation on clinical outcomes and complications following unilateral biportal endoscopy (UBE) for lumbar disc herniation (LDH). Methods: A systematic review and meta-analysis was conducted in accordance with PRISMA 2020 guidelines. PubMed, Embase, Web of Science, and Cochrane Library were searched up to February 2025. Eligible studies were grouped based on ambulation timing: early (<24 hours) versus late (≥24 hours). Outcomes included changes in leg pain and back pain measured by the visual analog scale (ΔVAS), functional recovery via the Oswestry Disability Index (ΔODI), complication rates, and patient satisfaction (MacNab criteria). A random-effects model was used to pool data and calculate weighted mean differences (WMDs) and 95% confidence intervals (CIs). Results: Fourteen retrospective studies comprising 715 patients were included (early group: 230; late group: 485). Early ambulation significantly improved leg pain within 3 days (WMD = −6.87; 95% CI: −7.48 to −6.26; p < 0.001) and at 6 months (WMD = −7.59; 95% CI: −7.98 to −7.20; p < 0.001), both exceeding the minimal clinically important difference. No significant between-group differences were observed for back pain (all time points), functional outcomes (ΔODI), complication rates, or patient satisfaction. Conclusions: Early ambulation (<24 hours) after UBE is associated with superior short-term relief of leg pain and does not increase postoperative complication risk. However, it offers no advantage in long-term pain, disability, or satisfaction. Early mobilization can be safely recommended as part of postoperative care, with individualized protocols based on patient and surgical factors.