Comparison of clinical efficacy and minimal invasiveness between unilateral biportal endoscopic and percutaneous endoscopic lumbar discectomy in the treatment of calcified lumbar disc herniation: a retrospective analysis

BACKGROUND: This study aimed to compare the clinical efficacy and minimal invasiveness of percutaneous endoscopic lumbar discectomy (PELD) and unilateral biportal endoscopic (UBE) in the treatment of calcified lumbar disc herniation (CLDH), to provide evidence for spinal surgeons to select the most appropriate surgical method for individual patients. METHODS: A retrospective analysis was conducted on the data of 49 CLDH patients who underwent PELD or UBE in our hospital from January 2016 to August 2024, including 20 who underwent PELD and 29 who underwent UBE. The demographic, clinical, and perioperative data of the two groups of patients were collected and analyzed. RESULTS: All surgeries were completed successfully, with significant improvement in clinical symptoms observed in both groups postoperatively. The mean fluoroscopy frequency was 5.52 times higher in the PELD group than in the UBE group. The average operative time in the PELD group was 9.21 min shorter than in the UBE group. The mean preoperative-to-postoperative difference in hemoglobin level was 3.65 g/L lower in the PELD group than in the UBE group. The mean preservation rate of the lumbar facet joints was 9.10% higher in the PELD group than in the UBE group. These differences were statistically significant (P < 0.05). The excellent-to-good rate was 90.00% in the PELD group and 93.10% in the UBE group. Additionally, two patients in the PELD group experienced complications, and two patients had recurrence at 12 months postoperatively, with no severe outcomes. No complications or postoperative recurrences were observed in the UBE group. CONCLUSIONS: PELD and UBE are both effective minimally invasive procedures for the treatment of CLDH. The short-term clinical efficacy of the two methods is similar; PELD is characterized by shorter operative time, less intraoperative blood loss, and less damage to facet joints. The advantages of UBE are more sufficient surgical field exposure and more flexible operation, though it may require a wider range of facet joint resection. Clinical decision-making should be based on the patient's clinical symptoms, imaging features, and the surgeon's procedural expertise to formulate an individualized surgical plan.