Title: Unilateral Biportal Endoscopic Discectomy Versus Microdiscectomy For Lumbar Disc Herniation: A Systematic Review And Meta-analysis
Authors: Muhammad Hassan Waseem, Zain ul Abideen, Sania Aimen, Justin Chen, Jamir Pitton Rissardo, Brandon Lucke-Wold
Conference: 2025 CNS Annual Meeting, Los Angeles, CA
Introduction
Lumbar disc herniation (LDH) is a prevalent spinal condition that leads to considerable disability, frequently necessitating minimally invasive surgical treatment such as Unilateral biportal endoscopic discectomy (UBED) and Microdiscectomy (MD).
Objective
This study aimed to compare the efficacy and safety of UBED versus MD for the treatment of LDH.
Methods
A literature search was conducted across PubMed, Cochrane Library, and ScienceDirect from inception to May 2025. This study evaluated the Visual Analog Scale (VAS) score, Oswestry Disability Index (ODI), MacNab scores, operative time, estimated blood loss, and length of hospitalization at various follow-up durations. The meta-analysis was performed using RevMan 5.4.1 software.
Results
The meta-analysis included 13 studies. The VAS scores for low back pain showed no significant differences between the two groups at postoperative 1–3 months (p = 0.06); however, the UBED group had lower VAS scores at postoperative 1–3 days (MD= -0.81; 95%CI:[-1.48,-0.14];p=0.02; I2= 95%) and 12-months (MD= -0.38; 95%CI:[-0.70,-0.06];p=0.02; I2= 47%). There were no significant differences in leg pain VAS scores at postoperative days 1–3 (p = 0.24), 1–3 months (p = 0.74), or at the 12-month follow-up (p = 0.49). ODI comparisons also revealed no significant differences at the postoperative 1-week (p = 0.47) and 1–3-month (p = 0.21) follow-ups, as well as at the final 12-month follow-up. The UBED group also exhibited a longer mean operative time (MD= 11.12 min; 95%CI:[3.45,18.79];p=0.005; I2= 93%), but significantly shorter hospital stay (MD= -1.47 days; 95%CI:[-2.50,-0.44];p=0.005; I2= 98%) and less estimated blood loss (MD= -74.42 ml; 95%CI:[-114.1,-34.73];p=0.0002; I2= 99%). MacNab scores also showed no significant differences between the two arms (p = 0.10).
Conclusions
The UBED group experienced significantly lower early postoperative pain at 1–3 days and sustained improvement at 12 months compared to MD. Additionally, it showed reduced blood loss and shorter hospital stays along with longer operative times.
Citation
Waseem MH, Abideen Z, Aimen S, Chen J, Pitton Rissardo J, Lucke-Wold B. Unilateral Biportal Endoscopic Discectomy Versus Microdiscectomy For Lumbar Disc Herniation: A Systematic Review And Meta-analysis. CNS Annual Meeting 2025;2025:5719. https://www.cns.org/poster-search?id=5719
Figure. Forest plots comparing VAS back pain scores for UBED vs. MD at 1–3 days, 1–3 months, and 12 months postoperatively.
Figure. Forest plots comparing VAS leg pain scores for UBED vs. MD at 1–3 days, 1–3 months, and 12 months postoperatively.
Figure. Forest plots comparing ODI scores for UBED vs. MD at 1–3 days, 1–3 months, and 12 months postoperatively.
Figure. Forest plots comparing UBED vs. MD for operative time, estimated blood loss, hospitalization length, and MacNab score.