Comparative outcomes of arthroscopy-assisted uniportal spinal surgery vs. unilateral biportal endoscopy for adjacent two-segment lumbar disc herniation: a retrospective cohort study

Purpose To compare the clinical efficacy and perioperative outcomes of arthroscopy-assisted uniportal spinal surgery (AUSS) and unilateral biportal endoscopy (UBE) for the treatment of adjacent two-segment lumbar disc herniation (AT-LDH). Methods In this retrospective cohort study, we analyzed the data of 59 patients with AT-LDH admitted to our department between January 2020 and May 2025. Of these, 33 patients underwent AUSS and 26 underwent UBE. The primary outcome measures were the visual analog scale (VAS) for low back and leg pain and Oswestry disability index (ODI). Secondary outcomes included operative time, number of intraoperative fluoroscopies, incision length, length of hospital stay, perioperative hemoglobin change, complications, facet joint preservation, and serum inflammatory markers. Results Both the AUSS and UBE groups exhibited significant postoperative improvements in VAS and ODI compared with baseline ( p < 0.05). No significant between-group differences in clinical efficacy were observed at any time point ( p > 0.05). The excellent-to-good rates were 87.9% for AUSS and 88.5% for UBE. No significant between-group differences in complication and facet joint preservation rates were found (AUSS: 6.1% vs. UBE: 7.7% and AUSS: 81.6% vs. UBE: 83.2%, respectively). However, the AUSS group showed shorter incision length and operative time, fewer fluoroscopic exposures, smaller postoperative hemoglobin decreases, and lower levels of inflammatory markers on postoperative day 3 (all p < 0.05). Conclusion Both AUSS and UBE provided satisfactory short-term clinical outcomes for AT-LDH. AUSS offers advantages of reduced invasiveness, greater surgical efficiency, and lower inflammatory response, supporting its broader clinical application.