Research Article: Percutaneous transforaminal endoscopic discectomy vs. unilateral biportal endoscopy for far lateral lumbar disc herniation: a retrospective comparative study
Abstract:
To compare the early clinical efficacy, perioperative parameters, and safety profiles of percutaneous transforaminal endoscopic discectomy (PTED) and unilateral biportal endoscopic (UBE) discectomy in treating single-level far lateral lumbar disc herniation (FLLDH).
This retrospective cohort study analyzed 81 patients with FLLDH treated between January 2021 and June 2024. Patients were allocated to the PTED group ( n =?38) or the UBE group ( n =?43) based on the surgical technique received. Perioperative indicators (operative time, incision length, blood loss, hospital stay) and clinical outcomes—assessed by Visual Analogue Scale (VAS) for back/leg pain and the Oswestry Disability Index (ODI) preoperatively and at 1, 3, 6, and 12 months postoperatively—were compared. Statistical analyses included independent samples t-tests, chi-square tests, and repeated-measures ANOVA.
All patients completed 12-month follow-up. The two groups were comparable at baseline ( P >?0.05). The PTED group demonstrated significantly shorter operative time (62.4?±?8.7 vs. 105.3?±?14.1?min, P <?0.001), smaller incision length (7.8?±?0.9 vs. 24.6?±?4.2?mm, P <?0.001), less intraoperative blood loss (18.5?±?4.3 vs. 68.2?±?10.5?mL, P <?0.001), and shorter hospital stay (4.8?±?1.1 vs. 5.9?±?1.7 days, P =?0.002). Both groups showed significant and sustained improvement in VAS and ODI scores postoperatively ( P <?0.05). At 1 month, PTED was associated with lower back pain VAS but slightly higher leg pain VAS and ODI compared to UBE ( P <?0.05). From 3 months onward, no significant inter-group differences were observed in any clinical scores ( P >?0.05). Repeated-measures ANOVA indicated a different improvement trajectory for back pain between the groups (interaction P =?0.024).
Both PTED and UBE are effective minimally invasive techniques for FLLDH, offering comparable and excellent mid-term clinical outcomes. PTED offers advantages in reduced surgical trauma and faster early recovery, whereas UBE provides superior endoscopic visualization. The choice of technique can be individualized based on patient characteristics and surgical expertise.
Introduction:
Far lateral lumbar disc herniation (FLLDH) refers to a specific type of lumbar disc herniation in which the herniated material is located inside or outside the intervertebral foramen, directly compressing the exiting nerve root at the same segment. Since its first clear description by Abdullah et al. ( 1 ) in 1974, its reported incidence accounts for approximately 6.5%–12% of all lumbar disc herniations ( 2 ). Due to its unique anatomical location, FLLDH often leads to severe radicular leg pain and neurological…
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