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June 17, 2026Open Access

Clinical and radiological outcomes of unilateral biportal endoscopy and percutaneous endoscopic interlaminar discectomy for highly downward-migrated lumbar disc herniation: a retrospective study

HLHaifeng LiuWenzhou Medical University SZSiping ZhangXinjiang Medical University ZKZhang KuixianWenzhou Medical University

Key Points

To compare the efficacy and safety of unilateral biportal endoscopy and percutaneous endoscopic interlaminar discectomy in treating highly downward-migrated lumbar disc herniation.
Retrospective analysis of 61 patients with HDM-LDH, divided into UBE (27 patients) and PEID (34 patients) groups.
Follow-up duration of 12 months, comparing perioperative indicators, MacNab rates, complications, and clinical/radiographic outcomes between groups.
Assessment included operation time, blood loss, postoperative hospital stay, VAS scores, and cross-sectional areas of spinal structures.
UBE group had a shorter operation time but greater intraoperative blood loss and longer postoperative hospital stay (P < 0.05).
Higher VAS-back scores for the UBE group at 3 days postoperative (P < 0.05) with no significant differences in VAS-leg and Oswestry disability index scores (P > 0.05).
UBE improved cross-sectional areas of the spinal canal and dural sac while having lower preservation of facet joints and reduced residual area of nucleus pulposus compared to PEID (P < 0.05).

Abstract

PURPOSE: To compare the clinical efficacy and safety of unilateral biportal endoscopy (UBE) versus percutaneous endoscopic interlaminar discectomy (PEID) in the treatment of highly downward-migrated lumbar disc herniation (HDM-LDH). METHOD: A retrospective study included 61 patients with HDM-LDH, comprising 27 in the UBE group and 34 in the PEID group. All patients followed up for 12 months. Compare differences in general information between the two groups. By analysing and comparing perioperative indicators, MacNab excellent/good rate, complication, and clinical and radiographic outcomes between the two groups. RESULTS: There were no significant differences between the two groups in general information (P > 0.05). The UBE group had a shorter operation time (OT), greater intraoperative blood loss (IBL) and longer postoperative hospital stay (PHS) than the PEID group (P 0.05). The visual analogue scale (VAS) - Back at 3 days postoperative in the UBE group was higher than PEID group (P 0.05). There were no significant differences between the two groups in intervertebral disc height (P>0.05). The cross-sectional area of the spinal canal (CASC) and cross-sectional area of the dural sac (CADS) in the UBE group were more significant than PEID group postoperative, and the cross-sectional area of the paraspinal muscles (CAPM) in the UBE group decreased more than PEID group postoperative (P < 0.05). The UBE group had a lower residual area of nucleus pulposus (RANP), a higher area of laminectomy (AL) and a lower preservation rate of facet joints (PRFJ) compared to the PEID group (P < 0.05). CONCLUSION: UBE yields higher AL, lower PRFJ, larger IBL and longer PHS compared with PEID. It also leads to more severe short-term postoperative low back pain and paraspinal muscle injury. Nevertheless, UBE possesses better surgical efficiency and shorter OT. It can better restore CASC and CADS, and reduce RANP simultaneously. In clinical practice, the surgical approach for HDM-LDH should be selected according to surgeon experience and individualized treatment strategies.

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