Comparison of unilateral biportal endoscopic decompression and percutaneous endoscopic lumbar decompression for single-segment degenerative lumbar spinal stenosis: a retrospective comparative study involving clinical efficacy and cost analysis

Objective To compare the clinical efficacy and hospitalization medical cost associated with unilateral biportal endoscopic decompression (UBED) vs. percutaneous endoscopic lumbar decompression (PELD) for the treatment of single-segment degenerative lumbar spinal stenosis (DLSS). Methods This retrospective study included 94 patients with single-segment DLSS, who received surgery between January 2023 and July 2025: 42 in UBED group and 52 in PELD group. Perioperative parameters, including intraoperative blood loss, fluoroscopy times, operative duration, time to postoperative ambulation, and length of hospital stay, were compared between groups. Additionally, patient-reported outcomes, namely, pain intensity (assessed using visual analog scale, VAS), functional disability (Oswestry disability index, ODI), and neurological function (Japanese Orthopaedic Association, JOA score), were evaluated preoperatively and at follow-up. Longitudinal between-group comparisons were performed using generalized estimating equations (GEE), with preoperative baseline scores as covariates and Bonferroni correction for post-hoc comparisons. Total and partial hospitalization costs were also compared. A generalized linear model (GLM) was employed to identify independent predictors of total hospitalization cost. Results With regard to perioperative parameters, intraoperative blood loss was significantly greater in UBED group than in PELD group, whereas fluoroscopy times were significantly lower in UBED group ( p < 0.05). No significant intergroup differences were detected in operative time, time to postoperative ambulation, or length of hospital stay ( p > 0.05). Both groups showed significant improvements in ODI, VAS, and JOA score from baseline at all follow-up points ( p < 0.05). In GEE analysis, UBED group showed lower VAS score for leg pain at 1 month, lower ODI at 1 and 6 months, and higher JOA score at 1 month ( p < 0.001). Excellent-good rate was 97.6% in UBED group, significantly higher than that in PELD group ( p = 0.039). Complication rate was significantly lower in UBED group (4.76%) than in PELD group (19.23%; p = 0.037). Total hospitalization cost was higher in UBED group than that in PELD group (17.46 vs. 15.82 × 10 3 RMB, p = 0.012). Multivariate regression analysis by GLM confirmed surgical approach, length of hospitalization, and intraoperative bleeding were independent predictors of total hospitalization cost. Conclusion Both UBED and PELD are safe and effective minimally invasive approaches for single-segment DLSS. UBED was associated with slightly better early functional outcomes at 1 month and a numerically lower complication rate, but at a higher hospitalization cost. However, PELD was associated with lower hospitalization cost. In clinical practice, the selection of operative strategy should be individualized, with consideration given to both the patient's clinical characteristics and socioeconomic circumstances, to optimize the balance between therapeutic benefit and healthcare resource utilization.