Clinical efficacy of unilateral biportal endoscopy in the treatment of lumbar disc herniation

Abstract Background With the advancement of minimally invasive spinal surgery, the use of unilateral biportal endoscopy (UBE) is gradually being implemented in clinical practice. The objective of this study was to assess the clinical efficacy and imaging results of UBE and fenestration discectomy (FD) in the treatment of lumbar disc herniation (LDH). Methods A retrospective analysis was performed on the data of 50 patients who underwent surgery for LDH in the Spinal Surgery Department of the Sixth Affiliated Hospital of Nantong University from June 2020 to December 2021, including 30 patients in the UBE group and 20 patients in the FD group. The two groups' operation time, incision length, postoperative hospital stay, and postoperative complications were compared. Back visual analog scale (VAS) and Oswestry disability index (ODI) preoperatively, 3 months, and 1 year postoperatively. Leg VAS preoperatively and 3 days, 3 months, and 1 year postoperatively improved the MacNab standard 1 year postoperatively. The superior lamina preservation rate (SLPR) and facet preservation rate (FPR) were calculated by lumbar three-dimensional CT reexamination 3 days postoperatively. Lumbar MRI was re-examined 3 months and 1 year postoperatively to calculate intervertebral disc height (IDH). Results There were no significant differences in sex, age, disease course, lesion space, prominence type, preoperative VAS score of the back and leg, ODI, or IDH between the two groups (P > 0.05). The operation time of the UBE group was longer than that of the FD group, and the difference between the two groups was statistically significant (P < 0.05). However, the incision length and postoperative hospital stay of the UBE group were better than those of the FD group, and the differences between the two groups were statistically significant (P < 0.05). There was one case of cerebrospinal fluid leakage in the UBE group, with a complication rate of 3.33%, and one case of intervertebral space infection in the FD group, with a complication rate of 5.00%, with no statistically significant difference between the two groups (P > 0.05). The back VAS score and ODI improved in the two groups at 3 months and 1 year postoperatively, and the differences between the two groups were statistically significant (P < 0.05). Leg VAS in both groups was significantly improved at 3 days, 3 months, and 1 year postoperatively, but there was no statistical significance between the two groups (P > 0.05). The excellent and good rate in the UBE group (93.33%) was better than that in the FD group (80.00%), but there was no statistical significance between the two groups (P > 0.05). The imaging results showed that SLPR, FPR, and IDH 3 months and 1 year postoperatively were significantly better than those in the FD group, and the difference between the two groups was statistically significant (P < 0.05). Conclusions UBE and FD can relieve nerve compression and improve leg pain. However, UBE has shorter hospital stays in the case of small incisions and can minimize soft tissue stripping in the lower back, preserve bone tissue, and reduce lower back pain. In the short-term follow-up one year postoperatively, UBE improved low back pain and dysfunction more effectively, and the satisfaction of patients was higher than that of the FD group.