Comparison of clinical efficacy and safety of biportal <i>versus</i> uniportal endoscopic interlaminar discectomy for lumbar disc herniation_West China Medical Journal

Authors：

LIAO Yehui ¹ , YE Rupei ² , TANG Chao ¹ , TANG Qiang ¹ , LENG Yebo ^1,3 ,  ZHONG Dejun ¹

1. Department of Orthopedics, the Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan 646000, P. R. China;
2. Department of Pathology, the Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan 646000, P. R. China;
3. Department of Orthopedics, the People’s Hospital of Meishan Tianfu New District, Meishan, Sichuan 620000, P. R. China;

Corresponding author：

ZHONG Dejun, Email: zdj_1974@163.com

Keywords：

Unilateral uniportal endoscopy; unilateral biportal endoscopy; discectomy; lumbar disc herniation; interlaminar

DOI：

10.7507/1002-0179.202407341

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Objective To compare the clinical efficacy and safety of unilateral biportal endoscopy discectomy (UBED) versus percutaneous uniportal endoscopic interlaminar discectomy (PEID) for the treatment of single lumbar disc herniation (sLDH). Methods A retrospective analysis was conducted on 52 patients with sLDH who underwent UBED or PEID at the Affiliated Hospital of Southwest Medical University between January 2022 and June 2023. Surgical parameters, clinical outcomes, and imaging indicators were compared between the two groups. For normally distributed quantitative data, mean ± standard deviation was used for representation, while for non-normally distributed data, median (lower quartile, upper quartile) was used for representation. Results No significant difference was observed between the two groups in terms of gender, age, disease duration, affected segments, preoperative Visual Analogue Scale (VAS) scores for low back and leg pain, preoperative Oswestry Disability Index (ODI) scores, preoperative disc height ratio (DHR), or preoperative sagittal rotation angle (SRA) (P>0.05). All patients successfully underwent surgery. In the UBED group, one case of cerebrospinal fluid leakage and one case of pseudomeningocele syndrome occurred postoperatively. In the PEID group, two cases of pseudomeningocele syndrome occurred postoperatively, and one case of recurrence was observed 1.5 years after surgery. Both groups showed significant improvements in VAS scores for low back and leg pain and ODI scores postoperatively and during follow-up compared to preoperative values (P<0.05). Significant differences were found between the UBED and PEID groups in terms of operation time [(138.3±28.0) vs. (113.5±34.2) min], intraoperative blood loss [(58.6±24.4) vs. (45.7±20.3) mL], postoperative drainage volume [(48.7±16.9) vs. (30.0±13.4) mL], postoperative ambulation time [3.4 (3.0, 4.0) vs. 2.3 (2.0, 3.0) d], and VAS scores for low back pain on postoperative Day 1 (2.87±0.55 vs. 2.24±0.65) (P<0.05). No significant difference was observed in intraoperative fluoroscopy frequency, VAS scores for leg pain on postoperative Day 1, VAS scores for low back and leg pain 6 months and 1 year after operation, postoperative hospital stay, postoperative complication rates, ODI scores 1 year after operation, DHR 1 year after operation, SRA 1 year after operation, or MacNab evaluation 1 year after operation (P>0.05). Conclusions Both UBED and PEID are safe and effective treatments for sLDH, with similar complication rates and clinical outcomes. However, PEID demonstrates advantages in reducing soft tissue damage and accelerating perioperative recovery.

Citation： LIAO Yehui, YE Rupei, TANG Chao, TANG Qiang, LENG Yebo, ZHONG Dejun. Comparison of clinical efficacy and safety of biportal versus uniportal endoscopic interlaminar discectomy for lumbar disc herniation. West China Medical Journal, 2024, 39(10): 1543-1550. doi: 10.7507/1002-0179.202407341 Copy

1.	Rickers KW, Pedersen PH, Tvedebrink T, et al. Comparison of interventions for lumbar disc herniation: a systematic review with network meta-analysis. Spine J, 2021, 21(10): 1750-1762.
2.	Song SK, Son S, Choi SW, et al. Comparison of the outcomes of percutaneous endoscopic interlaminar lumbar discectomy and open lumbar microdiscectomy at the L₅-S₁ level. Pain Physician, 2021, 24(4): E467-E475.
3.	Kim SK, Kang SS, Hong YH, et al. Clinical comparison of unilateral biportal endoscopic technique versus open microdiscectomy for single-level lumbar discectomy: a multicenter, retrospective analysis. J Orthop Surg Res, 2018, 13(1): 22.
4.	Chang H, Xu J, Yang D, et al. Comparison of full-endoscopic foraminoplasty and lumbar discectomy (FEFLD), unilateral biportal endoscopic (UBE) discectomy, and microdiscectomy (MD) for symptomatic lumbar disc herniation. Eur Spine J, 2023, 32(2): 542-554.
5.	Wang A, Yu Z. Comparison of percutaneous endoscopic lumbar discectomy with minimally invasive transforaminal lumbar interbody fusion as a revision surgery for recurrent lumbar disc herniation after percutaneous endoscopic lumbar discectomy. Ther Clin Risk Manag, 2020, 16: 1185-1193.
6.	Kim HS, Park JY. Comparative assessment of different percutaneous endoscopic interlaminar lumbar discectomy (PEID) techniques. Pain Physician, 2013, 16(4): 359-367.
7.	Pan M, Li Q, Li S, et al. Percutaneous endoscopic lumbar discectomy: indications and complications. Pain Physician, 2020, 23(1): 49-56.
8.	Hong YH, Kim SK, Suh DW, et al. Novel instruments for percutaneous biportal endoscopic spine surgery for full decompression and dural management: a comparative analysis. Brain Sci, 2020, 10(8): 516.
9.	Lee SH, Chung SE, Ahn Y, et al. Comparative radiologic evaluation of percutaneous endoscopic lumbar discectomy and open microdiscectomy: a matched cohort analysis. Mt Sinai J Med, 2006, 73(5): 795-801.
10.	Mochida J, Nishimura K, Nomura T, et al. Appropriate procedures of posterior herniotomy and percutaneous nucleotomy in lumbar disc herniation. Rinsho Seikei Geka, 1994, 29: 423-430.
11.	Lee DY, Shim CS, Ahn Y, et al. Comparison of percutaneous endoscopic lumbar discectomy and open lumbar microdiscectomy for recurrent disc herniation. J Korean Neurosurg Soc, 2009, 46(6): 515-521.
12.	Herkowitz HN, Garfin S, Balderston R, et al. Rothman-Simeone, the spine. 4 ed. Philadelphia: WB Saunders Company, 1999: 1089-1093.
13.	张立国, 朱裕昌, 徐玉良, 等. 退变性腰椎不稳症的诊断与治疗. 中国脊柱脊髓杂志, 2002(5): 15-17.
14.	Choi KC, Kim JS, Park CK. Percutaneous endoscopic lumbar discectomy as an alternative to open lumbar microdiscectomy for large lumbar disc herniation. Pain Physician, 2016, 19(2): E291-E300.
15.	Choi KC, Lee DC, Shim HK, et al. A strategy of percutaneous endoscopic lumbar discectomy for migrated disc herniation. World Neurosurg, 2017, 99: 259-266.
16.	De Antoni DJ, Claro ML, Poehling GG, et al. Translaminar lumbar epidural endoscopy: anatomy, technique, and indications. Arthroscopy, 1996, 12(3): 330-334.
17.	Choi DJ, Choi CM, Jung JT, et al. Learning curve associated with complications in biportal endoscopic spinal surgery: challenges and strategies. Asian Spine J, 2016, 10(4): 624-629.
18.	Pao JL, Lin SM, Chen WC, et al. Unilateral biportal endoscopic decompression for degenerative lumbar canal stenosis. J Spine Surg, 2020, 6(2): 438-446.
19.	Aygun H, Abdulshafi K. Unilateral biportal endoscopy versus tubular microendoscopy in management of single level degenerative lumbar canal stenosis: a prospective study. Clin Spine Surg, 2021, 34(6): E323-e328.
20.	Wu S, Zhong D, Zhao G, et al. Comparison of clinical outcomes between unilateral biportal endoscopic discectomy and percutaneous endoscopic interlaminar discectomy for migrated lumbar disc herniation at lower lumbar spine: a retrospective controlled study. J Orthop Surg Res, 2024, 19(1): 21.
21.	Wang L, Li C, Han K, et al. Comparison of clinical outcomes and muscle invasiveness between unilateral biportal endoscopic discectomy and percutaneous endoscopic interlaminar discectomy for lumbar disc herniation at L₅/S₁ level. Orthop Surg, 2023, 15(3): 695-703.
22.	Lee CW, Yoon KJ, Kim SW. Percutaneous endoscopic decompression in lumbar canal and lateral recess stenosis - the surgical learning curve. Neurospine, 2019, 16(1): 63-71.
23.	Ahn Y, Lee S. Uniportal versus biportal endoscopic spine surgery: a comprehensive review. Expert Rev Med Devices, 2023, 20(7): 549-556.
24.	王宁, 贝朝涌, 万健, 等. 单侧双通道脊柱内镜技术行腰椎椎间融合术学习曲线研究. 中国修复重建外科杂志, 2022, 36(10): 1229-1233.
25.	王海峰, 宋扬, 王乃国. 单侧双通道脊柱内镜与经皮内镜及椎板间开窗髓核摘除术治疗腰椎间盘突出症临床对比研究. 中国修复重建外科杂志, 2022, 36(10): 1200-1206.
26.	左如俊, 马明, 蒋毅, 等. 经椎板间入路单侧双通道脊柱内镜技术与经椎板间窗单通道内镜技术治疗 L₅、S₁ 椎间盘突出症疗效比较. 中国修复重建外科杂志, 2022, 36(10): 1192-1199.
27.	Choi KC, Shim HK, Hwang JS, et al. Comparison of surgical invasiveness between microdiscectomy and 3 different endoscopic discectomy techniques for lumbar disc herniation. World Neurosurg, 2018, 116: e750-e758.
28.	Xu WB, Kotheeranurak V, Zhang HL, et al. Is biportal endoscopic spine surgery more advantageous than uniportal for the treatment of lumbar degenerative disease? A meta-analysis. Medicina (Kaunas), 2022, 58(11): 1523.
29.	Hwa Eum J, Hwa Heo D, Son SK, et al. Percutaneous biportal endoscopic decompression for lumbar spinal stenosis: a technical note and preliminary clinical results. J Neurosurg Spine, 2016, 24(4): 602-607.
30.	Abumi K, Panjabi MM, Kramer KM, et al. Biomechanical evaluation of lumbar spinal stability after graded facetectomies. Spine (Phila Pa 1976), 1990, 15(11): 1142-1147.
31.	Lu WW, Luk KD, Ruan DK, et al. Stability of the whole lumbar spine after multilevel fenestration and discectomy. Spine (Phila Pa 1976), 1999, 24(13): 1277-1282.
32.	Okawa A, Shinomiya K, Takakuda K, et al. A cadaveric study on the stability of lumbar segment after partial laminotomy and facetectomy with intact posterior ligaments. J Spinal Disord, 1996, 9(6): 518-526.
33.	Vodičar M, Košak R, Gorenšek M, et al. Vertebral end-plate perforation for intervertebral disc height preservation after single-level lumbar discectomy: a randomized-controlled trial. Clin Spine Surg, 2017, 30(6): E707-E712.
34.	Bresnahan LE, Smith JS, Ogden AT, et al. Assessment of paraspinal muscle cross-sectional area after lumbar decompression: minimally invasive versus open approaches. Clin Spine Surg, 2017, 30(3): E162-E168.
35.	Kim HS, Paudel B, Jang JS, et al. Percutaneous full endoscopic bilateral lumbar decompression of spinal stenosis through uniportal-contralateral approach: techniques and preliminary results. World Neurosurg, 2017, 103: 201-209.
36.	Minamide A, Yoshida M, Yamada H, et al. Clinical outcomes after microendoscopic laminotomy for lumbar spinal stenosis: a 5-year follow-up study. Eur Spine J, 2015, 24(2): 396-403.
37.	Choi DJ, Kim JE, Jung JT, et al. Biportal endoscopic spine surgery for various foraminal lesions at the lumbosacral lesion. Asian Spine J, 2018, 12(3): 569-573.

1. Rickers KW, Pedersen PH, Tvedebrink T, et al. Comparison of interventions for lumbar disc herniation: a systematic review with network meta-analysis. Spine J, 2021, 21(10): 1750-1762.
2. Song SK, Son S, Choi SW, et al. Comparison of the outcomes of percutaneous endoscopic interlaminar lumbar discectomy and open lumbar microdiscectomy at the L₅-S₁ level. Pain Physician, 2021, 24(4): E467-E475.
3. Kim SK, Kang SS, Hong YH, et al. Clinical comparison of unilateral biportal endoscopic technique versus open microdiscectomy for single-level lumbar discectomy: a multicenter, retrospective analysis. J Orthop Surg Res, 2018, 13(1): 22.
4. Chang H, Xu J, Yang D, et al. Comparison of full-endoscopic foraminoplasty and lumbar discectomy (FEFLD), unilateral biportal endoscopic (UBE) discectomy, and microdiscectomy (MD) for symptomatic lumbar disc herniation. Eur Spine J, 2023, 32(2): 542-554.
5. Wang A, Yu Z. Comparison of percutaneous endoscopic lumbar discectomy with minimally invasive transforaminal lumbar interbody fusion as a revision surgery for recurrent lumbar disc herniation after percutaneous endoscopic lumbar discectomy. Ther Clin Risk Manag, 2020, 16: 1185-1193.
6. Kim HS, Park JY. Comparative assessment of different percutaneous endoscopic interlaminar lumbar discectomy (PEID) techniques. Pain Physician, 2013, 16(4): 359-367.
7. Pan M, Li Q, Li S, et al. Percutaneous endoscopic lumbar discectomy: indications and complications. Pain Physician, 2020, 23(1): 49-56.
8. Hong YH, Kim SK, Suh DW, et al. Novel instruments for percutaneous biportal endoscopic spine surgery for full decompression and dural management: a comparative analysis. Brain Sci, 2020, 10(8): 516.
9. Lee SH, Chung SE, Ahn Y, et al. Comparative radiologic evaluation of percutaneous endoscopic lumbar discectomy and open microdiscectomy: a matched cohort analysis. Mt Sinai J Med, 2006, 73(5): 795-801.
10. Mochida J, Nishimura K, Nomura T, et al. Appropriate procedures of posterior herniotomy and percutaneous nucleotomy in lumbar disc herniation. Rinsho Seikei Geka, 1994, 29: 423-430.
11. Lee DY, Shim CS, Ahn Y, et al. Comparison of percutaneous endoscopic lumbar discectomy and open lumbar microdiscectomy for recurrent disc herniation. J Korean Neurosurg Soc, 2009, 46(6): 515-521.
12. Herkowitz HN, Garfin S, Balderston R, et al. Rothman-Simeone, the spine. 4 ed. Philadelphia: WB Saunders Company, 1999: 1089-1093.
13. 张立国, 朱裕昌, 徐玉良, 等. 退变性腰椎不稳症的诊断与治疗. 中国脊柱脊髓杂志, 2002(5): 15-17.
14. Choi KC, Kim JS, Park CK. Percutaneous endoscopic lumbar discectomy as an alternative to open lumbar microdiscectomy for large lumbar disc herniation. Pain Physician, 2016, 19(2): E291-E300.
15. Choi KC, Lee DC, Shim HK, et al. A strategy of percutaneous endoscopic lumbar discectomy for migrated disc herniation. World Neurosurg, 2017, 99: 259-266.
16. De Antoni DJ, Claro ML, Poehling GG, et al. Translaminar lumbar epidural endoscopy: anatomy, technique, and indications. Arthroscopy, 1996, 12(3): 330-334.
17. Choi DJ, Choi CM, Jung JT, et al. Learning curve associated with complications in biportal endoscopic spinal surgery: challenges and strategies. Asian Spine J, 2016, 10(4): 624-629.
18. Pao JL, Lin SM, Chen WC, et al. Unilateral biportal endoscopic decompression for degenerative lumbar canal stenosis. J Spine Surg, 2020, 6(2): 438-446.
19. Aygun H, Abdulshafi K. Unilateral biportal endoscopy versus tubular microendoscopy in management of single level degenerative lumbar canal stenosis: a prospective study. Clin Spine Surg, 2021, 34(6): E323-e328.
20. Wu S, Zhong D, Zhao G, et al. Comparison of clinical outcomes between unilateral biportal endoscopic discectomy and percutaneous endoscopic interlaminar discectomy for migrated lumbar disc herniation at lower lumbar spine: a retrospective controlled study. J Orthop Surg Res, 2024, 19(1): 21.
21. Wang L, Li C, Han K, et al. Comparison of clinical outcomes and muscle invasiveness between unilateral biportal endoscopic discectomy and percutaneous endoscopic interlaminar discectomy for lumbar disc herniation at L₅/S₁ level. Orthop Surg, 2023, 15(3): 695-703.
22. Lee CW, Yoon KJ, Kim SW. Percutaneous endoscopic decompression in lumbar canal and lateral recess stenosis - the surgical learning curve. Neurospine, 2019, 16(1): 63-71.
23. Ahn Y, Lee S. Uniportal versus biportal endoscopic spine surgery: a comprehensive review. Expert Rev Med Devices, 2023, 20(7): 549-556.
24. 王宁, 贝朝涌, 万健, 等. 单侧双通道脊柱内镜技术行腰椎椎间融合术学习曲线研究. 中国修复重建外科杂志, 2022, 36(10): 1229-1233.
25. 王海峰, 宋扬, 王乃国. 单侧双通道脊柱内镜与经皮内镜及椎板间开窗髓核摘除术治疗腰椎间盘突出症临床对比研究. 中国修复重建外科杂志, 2022, 36(10): 1200-1206.
26. 左如俊, 马明, 蒋毅, 等. 经椎板间入路单侧双通道脊柱内镜技术与经椎板间窗单通道内镜技术治疗 L₅、S₁ 椎间盘突出症疗效比较. 中国修复重建外科杂志, 2022, 36(10): 1192-1199.
27. Choi KC, Shim HK, Hwang JS, et al. Comparison of surgical invasiveness between microdiscectomy and 3 different endoscopic discectomy techniques for lumbar disc herniation. World Neurosurg, 2018, 116: e750-e758.
28. Xu WB, Kotheeranurak V, Zhang HL, et al. Is biportal endoscopic spine surgery more advantageous than uniportal for the treatment of lumbar degenerative disease? A meta-analysis. Medicina (Kaunas), 2022, 58(11): 1523.
29. Hwa Eum J, Hwa Heo D, Son SK, et al. Percutaneous biportal endoscopic decompression for lumbar spinal stenosis: a technical note and preliminary clinical results. J Neurosurg Spine, 2016, 24(4): 602-607.
30. Abumi K, Panjabi MM, Kramer KM, et al. Biomechanical evaluation of lumbar spinal stability after graded facetectomies. Spine (Phila Pa 1976), 1990, 15(11): 1142-1147.
31. Lu WW, Luk KD, Ruan DK, et al. Stability of the whole lumbar spine after multilevel fenestration and discectomy. Spine (Phila Pa 1976), 1999, 24(13): 1277-1282.
32. Okawa A, Shinomiya K, Takakuda K, et al. A cadaveric study on the stability of lumbar segment after partial laminotomy and facetectomy with intact posterior ligaments. J Spinal Disord, 1996, 9(6): 518-526.
33. Vodičar M, Košak R, Gorenšek M, et al. Vertebral end-plate perforation for intervertebral disc height preservation after single-level lumbar discectomy: a randomized-controlled trial. Clin Spine Surg, 2017, 30(6): E707-E712.
34. Bresnahan LE, Smith JS, Ogden AT, et al. Assessment of paraspinal muscle cross-sectional area after lumbar decompression: minimally invasive versus open approaches. Clin Spine Surg, 2017, 30(3): E162-E168.
35. Kim HS, Paudel B, Jang JS, et al. Percutaneous full endoscopic bilateral lumbar decompression of spinal stenosis through uniportal-contralateral approach: techniques and preliminary results. World Neurosurg, 2017, 103: 201-209.
36. Minamide A, Yoshida M, Yamada H, et al. Clinical outcomes after microendoscopic laminotomy for lumbar spinal stenosis: a 5-year follow-up study. Eur Spine J, 2015, 24(2): 396-403.
37. Choi DJ, Kim JE, Jung JT, et al. Biportal endoscopic spine surgery for various foraminal lesions at the lumbosacral lesion. Asian Spine J, 2018, 12(3): 569-573.

West China Medical Journal

Comparison of clinical efficacy and safety of biportal versus uniportal endoscopic interlaminar discectomy for lumbar disc herniation

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