Comparing Unilateral Biportal Endoscopic Discectomy Versus Microdiscectomy for Lumbar Disc Herniation: A Systematic Review and Meta-Analysis

Study DesignThis study is a meta-analysis of randomized controlled trials (RCTs) and observational studies.ObjectiveLumbar disc herniation (LDH) often requires surgery, with microdiscectomy (MD) being common. This study compares Unilateral Biportal Endoscopic Discectomy (UBED) to conventional and tubular MD for LDH treatment.MethodsPubMed, Cochrane Central, and ScienceDirect were searched up to May 2025. Mean differences (MDs) and risk ratios (RRs) were pooled with a random effects model using Review Manager. Quality was assessed using the Cochrane risk of bias tool and the Newcastle-Ottawa Scale. Publication bias was evaluated with funnel plots and Egger's regression test.ResultsThirteen studies (11 observational studies and 2 RCTs), pooling 1369 patients, were included. UBED was associated with decreased 1-3 days post-operative (MD: -0.81; 95% CI: [-1.48, -0.14]; <i>P</i> = 0.02) and 12 months post-operative (MD: -0.37; 95% CI: [-0.74, -0.01]; <i>P</i> = 0.04) VAS back pain scores, 12 months post-operative ODI scores (MD: -1.32; 95% CI: [-2.44, -0.19]; <i>P</i> = 0.02), estimated blood loss (MD: -74.42; 95% CI: [-114.11, -34.73]; <i>P</i> = 0.0002), and hospital stay (MD: -1.81; 95% CI: [-2.99, -0.63]; <i>P</i> = 0.003) compared to conventional MD although the operative time was high (MD: 9.07; 95% CI: [1.66, 16.48]; <i>P</i> = 0.02). Concurrently, the 12 months post-operative VAS back pain score (MD: -0.42; 95% CI: [-1.40, 0.56]; <i>P</i> = 0.40) and ODI score (MD: 1.39; 95% CI: [-2.80, 5.58]; <i>P</i> = 0.52) along with the operative time (MD: 21.80; 95% CI: [-26.31, 69.92]; <i>P</i> = 0.37) and hospital stay (MD: 0.02; 95% CI: [-0.30, 0.33]; <i>P</i> = 0.92) were comparable between the UBED and tubular MD. The VAS leg pain scores were comparable between UBED and both conventional and tubular MD.ConclusionUBED may be associated with reduced early and long-term back pain, disability, blood loss, and hospital stays compared to conventional MD, but has longer surgery times, with comparable outcomes to tubular MD. More large-scale RCTs are required to validate these results.