Unilateral biportal endoscopic discectomy versus percutaneous endoscopic lumbar discectomy in the treatment of far-lateral lumbar disc herniation.

To compare the safety and efficacy of unilateral biportal endoscopic discectomy (UBE) and percutaneous endoscopic lumbar discectomy (PELD) for the treatment of patients with far-lateral lumbar disc herniation (FLLDH). Clinical data from 121 patients who underwent PELD or UBE surgery for FLLDH at our hospital between January 2021 and January 2023 were retrospectively analyzed. Patients were divided into the PELD and UBE groups based on the surgical method used. Clinical outcomes between the two groups were compared and analyzed based on operation time, hospital stay, total blood loss (TBL), intraoperative blood loss (IBL), hidden blood loss (HBL), complications, total hospital costs, visual analog scale (VAS) scores for low back and leg pain, Oswestry Disability Index (ODI), and modified MacNab criteria. The learning curve was evaluated using cumulative sum (CUSUM) and risk-adjusted cumulative sum (RA-CUSUM) analyses. The study included 121 patients, with 63 in the PELD group and 58 in the UBE group. Both groups showed significant decreases in postoperative VAS scores and ODI. However, there were no statistically significant differences in VAS scores or ODI between the two groups at the preoperative stage or at 1 month, 3 months, 6 months, and the final follow-up (P > 0.05). Compared to the PELD group, the UBE group had higher TBL, IBL, and HBL, longer operative time, extended hospitalization, and higher total hospital costs (P < 0.05). There was no statistically significant difference in complication rates between the two groups (P > 0.05). Learning curve analysis showed that proficiency in surgical techniques was achieved after 36 cases in the PELD group and 27 cases in the UBE group, there was no significant difference in clinical outcomes between the two groups (P > 0.05). Both PELD and UBE are effective for treating FLLDH, with comparable long-term outcomes. PELD offers advantages in operative time, intraoperative bleeding, hospitalization duration, and overall hospitalization costs. However, achieving mastery in PELD necessitates a learning curve of 36 cases, while UBE requires a minimum of 27 cases to reach proficiency.