Clinical outcomes of unilateral biportal endoscopic discectomy vs. microdiscectomy in lumbar disc herniation

Background Lumbar disc herniation (LDH) often causes radiculopathy, resulting in unilateral leg pain and lower back discomfort. Minimally invasive techniques such as microscopic discectomy (MSLD) and unilateral biportal endoscopic (UBE) discectomy are widely used. However, comparative data are limited. This study compares the clinical outcomes and complications of UBE and MSLD. Methods A single-center, retrospective, non-randomized analysis was conducted on 80 patients with LDH who underwent surgical treatment at People’s Hospital of Suzhou New District between January 2021 and September 2023. Patients were categorized according to the surgical technique received into a microscope group (MG, n = 38) and endoscopic group (EG, n = 42). Pre- and postoperative pain (VAS), functional recovery (ODI, JOA), and intervertebral space height were assessed. Postoperative efficacy and complication rates were evaluated at a 6-month follow-up. Results Compared with MG, the EG group was associated with shorter operation and hospitalization times and less intraoperative blood loss ( p = 0.03, p = 0.02). VAS, ODI, and JOA scores improved over time in both groups, with greater early improvements observed in EG at 3 days, 3 months, and 6 months postoperatively ( p = 0.04, p = 0.01, p = 0.02). At 6 months, EG was also associated with better preservation of intervertebral space height ( p = 0.04). No statistically significant differences were observed between groups in terms of overall clinical efficacy or postoperative complication rates ( p > 0.05). Conclusion Both UBE and MSLD are effective surgical options for the treatment of LDH. The findings suggest that UBE may offer advantages in surgical efficiency, early pain relief, functional recovery, and intervertebral space preservation. Given the retrospective, non-randomized design, selection bias and residual confounding cannot be entirely excluded, so these associative findings require confirmation in prospective studies with longer follow-up.