Unilateral biportal endoscopy versus microscopic discectomy for far-lateral lumbar disc herniations: A retrospective comparative study

Aim: Far-lateral lumbar disc herniations (FLLDH) account for approximately 7–12% of all lumbar disc herniations and require specific surgical approaches due to their anatomical location. This study aimed to compare the clinical outcomes of Unilateral Biportal Endoscopy (UBE) and microscopic discectomy in the treatment of FLLDH. Material and Methods: A retrospective comparative analysis was conducted on 20 patients who underwent surgery for FLLDH between January 2023 and January 2025. Patients were divided into two groups: 10 treated with UBE and 10 with microscopic discectomy. Demographic data, operative time, pre- and postoperative back and leg Visual Analog Scale (VAS) scores, Oswestry Disability Index (ODI) scores, hemoglobin (Hb) levels, length of hospital stay, functional outcomes (modified McNab criteria), and complications were analyzed. Normality was assessed using the Shapiro–Wilk test. Paired t-tests or Wilcoxon signedrank tests were used for within-group before–after comparisons, and independent t-tests or chi-square tests were used for between-group comparisons. A p-value < 0.05 was considered statistically significant. Results: The mean age and sex distribution were similar between the groups. Postoperative back pain VAS scores were significantly lower in the UBE group (2.2±0.9 vs. 4.1±1.7, p=0.005). ODI scores improved significantly in both groups without a significant intergroup difference. Postoperative Hb levels were significantly higher in the UBE group (12.8±0.7 g/dL vs. 12.1±0.6 g/dL, p=0.011), indicating less blood loss. Hospital stay was shorter in the UBE group (16.8±5.8 h vs. 23.0±4.8 h, p=0.012). Operative time and complication rates were comparable. According to modified McNab criteria, functional outcomes did not differ significantly. Conclusion: UBE provides similar functional outcomes to microscopic discectomy in FLLDH, with advantages of less postoperative pain, reduced blood loss, and shorter hospitalization. UBE is a safe and effective minimally invasive alternative; however, larger prospective studies are required to confirm long-term outcomes.