Comparison of outcomes after unilateral biportal endoscopic discectomy versus percutaneous endoscopic lumbar discectomy for lumbar disc herniation: a systematic review and meta-analysis of observational studies

Abstract

Background
One of the most common causes of lower back and radicular leg discomfort, especially in those between the ages of 30 and 50, is lumbar disc herniation (LDH). It frequently affects mobility and quality of life and is caused by disc debris squeezing spinal nerves. In order to treat LDH, this study contrasts the perioperative results, safety, and effectiveness of unilateral biportal endoscopic discectomy (UBED) and percutaneous endoscopic lumbar discectomy (PELD).


Methods
PubMed, Embase, and Cochrane databases were systematically searched using relevant keywords from inception until July 2025. A total of nine studies were included after final screening. Outcomes were reported as Change in VAS Leg at 6 months, Change in VAS back at 6 months, Change in ODI at 6 months, Operating time, etc. Interstudy heterogeneity was assessed using I² and X² statistics (I²>50%=significant heterogeneity). Statistical calculations were performed using Review Manager 5.4.1 (The Cochrane Collaboration, Copenhagen, Denmark), with a p-value of < 0.05 indicating statistical significance.


Results

This meta-analysis included 9 observational studies with 845 patients, with 387 in the UBED group and 458 in the PELD group. Both procedures showed comparable improvement in leg pain (VAS Leg: MD = 0.16; 95% CI: − 0.06 to 0.38;
p
 = 0.15), back pain (VAS Back: MD = 0.12; 95% CI: − 0.12 to 0.36;
p
 = 0.32), and functional outcomes (ODI: MD = 2.63; 95% CI: − 10.14 to 15.39;
p
 = 0.69). However, PELD was associated with shorter operative time (MD = 16.66 min; 95% CI: 7.48 to 25.83;
p
 < 0.001), less intraoperative blood loss (MD = 33.99 mL; 95% CI: 17.32 to 50.65;
p
 < 0.0001), and shorter hospital stay (MD = 1.80 days; 95% CI: 0.33 to 3.27;
p
 = 0.02). Complication rates were statistically similar between groups (RR = 0.76; 95% CI: 0.30 to 1.96;
p
 = 0.58).



Conclusion
For Lumbar Disc Herniation, UBED and PELD offered similar clinical results. PELD, however, exhibits benefits in terms of recovery (shorter hospital stay), blood loss, and operating time. UBED is still useful for complicated herniations. Additional high-quality studies are required to validate long-term safety and effectiveness.