Title: Unilateral Biportal Endoscopic Discectomy Versus Percutaneous Endoscopic Lumbar Discectomy 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
Unilateral biportal endoscopic discectomy (UBED) represents a cutting-edge, minimally invasive approach to treating lumbar disc herniation (LDH). Nonetheless, the effectiveness and safety of UBED in relation to traditional percutaneous endoscopic lumbar discectomy (PELD) have yet to be established.
Objective
This study conducted a meta-analysis to compare UBED with PELD for LDH.
Methods
Relevant cohort studies and clinical trials were found by searching PubMed, Cochrane Central, and ScienceDirect from inception till May 2025. Mean differences (MD) and Risk Ratios (RR) were pooled using the random effects model in Review Manager. Outcomes analyzed were operative time, length of hospitalization, visual analogue scale (VAS) for leg and back, Oswestry disability index (ODI), perioperative complications, and LDH recurrence.
Results
This meta-analysis included 23 studies. Pooled results showed that, compared with PELD, UBED was associated with a longer surgery time (MD = 12.91 min; 95% CI: [7.71, 18.12]; p < 0.00001; I2 = 91%) and hospital stay (MD= 1.21 day; 95%CI:[0.44,1.97]; p=0.002; I2= 95%). However, UBED and PELD showed comparative efficacies in improving the VAS of leg (MD= 0.02; 95%CI:[-0.12,0.17]; p=0.73; I2=21%) and back (MD= 0.09; 95%CI:[-0.07,0.26]; p=0.28; I2= 40%), and Oswestry Disability Index (MD= 0.44; 95%CI:[-1.03,1.90]; p=0.56; I2= 78%), scores. The incidence of perioperative complications was not significantly different between the two techniques (RR= 1.09; 95%CI:[0.74,1.62]; p=0.66; I2= 0%), while UBED was associated with a lower LDH recurrence during follow-up (RR= 0.31; 95%CI:[0.14,0.68]; p=0.003; I2=0%).
Conclusions
While UBED resulted in longer surgery and hospital stays, it demonstrated comparable effectiveness to PELD in relieving pain and improving functional capacity in patients with LDH. Additionally, UBED was associated with a lower recurrence of LDH compared to PELD, with no difference in the rate of perioperative complications. These results support UBED as a viable treatment option for patients with LDH.
Citation
Waseem MH, Abideen Z, Aimen S, Chen J, Pitton Rissardo J, Lucke-Wold B. Unilateral Biportal Endoscopic Discectomy Versus Percutaneous Endoscopic Lumbar Discectomy For Lumbar Disc Herniation: A Systematic Review And Meta-analysis. CNS Annual Meeting 2025;2025:5832. https://www.cns.org/poster-search?id=5832
Figure. Forest plots comparing UBED and PELD for lumbar disc herniation: operative time and length of hospitalization.
Figure. Forest plots comparing UBE and PELD for lumbar disc herniation: Visual Analogue Scale (leg, back) and Oswestry Disability Index outcomes.
Figure. Forest plots comparing UBED and PELD for lumbar disc herniation: perioperative complications and recurrence rates with pooled risk ratios and heterogeneity statistics.