The clinical efficacy of biportal endoscopy is comparable to that of uniportal endoscopy via the interlaminar approach for the treatment of L5/S1 lumbar disc herniation

OBJECTIVE: To compare the clinical outcomes of unilateral biportal endoscopy/biportal endoscopic spinal surgery (UBE/BESS) via the posterior approach with those of interlaminar endoscopic lumbar discectomy (IELD) for the treatment of L5/S1 lumbar disc herniation. METHODS: We collected the clinical data of patients with L5/S1 lumbar disc herniation who had undergone endoscopic surgery at our center from January 2020 to July 2021, and 92 patients were included. They were divided into UBE/BESS (n = 42) and IELD (n = 50) groups. The incision length, operative time (overall operative, extracanal operative, and intracanal decompression times), intraoperative radiation exposure dose, changes in hemoglobin before and after surgery, postoperative hospital stay, visual analog scale (VAS) score for low back pain and leg, and Oswestry disability index (ODI) were statistically analyzed. RESULTS: One case incurred dural tear in the UBE/BESS group, and one case developed recurrence in the IELD group. Postoperatively, the VAS score and ODI index decreased significantly in both groups (P < 0.01). VAS and ODI scores (preoperative as well as 3 days, 3 months, 6 months, and 12 months after surgery), the overall operative time, and postoperative hospital stay were not significantly different between the two groups (P > 0.05). No statistical difference in intraoperative radiation exposure dose was noted between the two groups (P > 0.05). The surgical incision length was greater in the UBE/BESS group (P < 0.01), and pre- and postoperative hemoglobin changes were more pronounced in the UBE/BESS group (P < 0.01). The UBE/BESS group had a longer extracanal operative time and shorter intracanal decompression time (P < 0.01). CONCLUSIONS: The clinical efficacy of UBE/BESS for L5/S1 lumbar disc herniation is comparable to that of IELD. Intraoperative radiation exposure doses were similar in both techniques. UBE/BESS required more time to identify tissue structures and a larger working space when operating outside the spinal canal; however, the efficiency of nucleus pulposus removal and nerve root release inside the spinal canal superseded that in IELD. Furthermore, the surgical incision in the UBE/BESS technique was longer, with greater actual blood loss during surgery, thus rendering UBE/BESS inferior to the IELD technique in terms of surgical trauma. Nonetheless, no significant difference was noted between the two techniques in the postoperative recovery time of patients.