Minimally invasive surgery is gaining traction as the preferred approach for treating various orthopedic conditions, including lumbar disc herniation. A recent study, published on March 17, 2025, compared two advanced surgical techniques—unilateral biportal endoscopic (UBE) discectomy and percutaneous interlaminar endoscopic lumbar discectomy (IELD)—to determine their effectiveness for high-grade down-migrated lumbar disc herniation (HDM-LDH).
Conducted over three years, the retrospective analysis included 39 patients suffering from HDM-LDH, treated at the First Affiliated Hospital of Guangzhou University of Chinese Medicine between January 2020 and February 2023. Of these patients, 18 underwent the UBE procedure, and 21 were treated with IELD. The goal was to evaluate the clinical outcomes based on key metrics such as operative time, blood loss, and recovery duration.
Results indicated notable differences between the two techniques. The IELD group experienced significantly shorter operative durations, less intraoperative blood loss, and reduced lengths of hospital stays compared to those who had UBE (P < 0.05). Specifically, the IELD method's minimally invasive nature led to these advantageous outcomes, highlighting its preference for surgical intervention when handling cases of this type.
One day following surgery, patients from the UBE group reported higher visual analog scale (VAS) scores for low back pain compared to their IELD counterparts, with statistical significance (P < 0.05). The VAS score is instrumental for assessing pain severity, where lower scores typically indicate effective pain management. Notably, both groups showed improvements over time, but the IELD approach consistently maintained its edge within this short recovery window.
Despite the differences observed in postoperative pain, no significant variations were noted between the two groups concerning lower limb pain at one day, one month, and three months post-surgery, as well as their respective Oswestry disability index (ODI) scores, which assess patient disability.
Interestingly, at the final follow-up, patient satisfaction rates were remarkably high, with 94.44% satisfaction noted among UBE patients versus 95.24% satisfaction for those undergoing IELD, indicating both techniques yield positive clinical results.
While both surgical options provided significant clinical efficacy for addressing the HDM-LDH conditions, there was one adverse neurological symptom reported within the IELD group post-surgery. This incident reinforces the importance of thorough preoperative screening and careful surgical technique execution.
The findings from this study affirm both UBE and IELD as effective treatments for HDM-LDH, but the research team advocates clinicians select the appropriate procedural technique based on individual patient profiles and clinical scenarios.
LDH affects about 1-3% of the population annually and can lead to debilitating pain and decreased mobility. HDM-LDH, characterized by downward displacement of disc material, complicates the condition and poses challenges for treatment. Effective surgical intervention can significantly improve functional outcomes and quality of life. The study sheds light on the contemporary surgical approaches available for alleviating the burden of this condition.
