Unilateral Biportal Endoscopy Versus Percutaneous Endoscopic Interlaminar Discectomy for Highly Migrated Lumbar Disc Herniation: A Retrospective Comparative Study With Quantitative MRI-Based Decompression Analysis

Study designRetrospective comparative cohort study.ObjectiveTo compare the perioperative, clinical, and radiographic outcomes of unilateral biportal endoscopy (UBE) and percutaneous endoscopic interlaminar discectomy (PEID) in the treatment of highly migrated lumbar disc herniation (HMLDH).MethodsA total of 128 patients with single-level HMLDH who underwent UBE (n = 63) or PEID (n = 65) between June 2022 and January 2024 were retrospectively reviewed. All patients completed a minimum follow-up period of 2 years. Perioperative variables, complications, and reoperation events were analyzed. Clinical outcomes were evaluated using the Visual Analog Scale (VAS) and the Oswestry Disability Index (ODI). Radiographic decompression was quantitatively assessed using the postoperative dural sac cross-sectional area (DSCA) expansion rate measured on magnetic resonance imaging (MRI).ResultsCompared with PEID, UBE was associated with a significantly shorter operative time, less endoscopic hemostasis time, and lower fluoroscopy time. Intraoperative blood loss was lower in the PEID group. Early postoperative back pain was significantly lower in the PEID group, whereas no significant between-group differences were observed in long-term VAS or ODI outcomes. The overall complication rate was significantly lower in the UBE group. In addition, UBE achieved a significantly greater DSCA expansion rate and a lower rate of residual disc fragments than PEID.ConclusionUBE and PEID achieved comparable long-term clinical outcomes in patients with HMLDH. UBE demonstrated advantages in perioperative efficiency, radiographic decompression, and reduced radiation exposure. Furthermore, UBE was associated with a lower overall complication rate, primarily attributable to a lower incidence of postoperative nerve root irritation.