Comparative Efficacy and Safety of Unilateral Biportal Endoscopic Discectomy versus Percutaneous Endoscopic Lumbar Discectomy for Lumbar Disc Herniation: A Systematic Review and Meta-Analysis

Introduction This meta-analysis was designed to comprehensively compare the perioperative and clinical outcomes of unilateral biportal endoscopic discectomy (UBE) versus percutaneous endoscopic lumbar discectomy (PELD) for lumbar disc herniation (LDH).Materials and Methods Four databases (PubMed, Embase, Web of Science, Cochrane Library) were systematically searched for comparative studies from inception to July 20, 2025. Operative time, intraoperative blood loss, incision length, intraoperative fluoroscopy times, overall complications, total and postoperative hospital stay, and reductions in Visual Analogue Scale (VAS) for back/leg pain and Oswestry Disability Index (ODI) at various time points were analyzed. Results Twenty-six studies involving 2,444 patients (UBE: 1,148; PELD: 1,296) were included. Compared to PELD, UBE was associated with longer operative time (WMD = 14.23 min, 95% CI: 13.44 to 15.02, P < 0.00001), greater blood loss (WMD = 23.88 mL, 95% CI: 23.01 to 24.75, P < 0.00001), longer total incision length (WMD = 1.02 cm, 95% CI: 0.98 to 1.06, P < 0.00001), and longer total (WMD = 0.34 days, 95% CI: 0.24 to 0.44, P < 0.00001) and postoperative (WMD = 1.33 days, 95% CI: 1.14 to 1.52, P < 0.00001) hospital stay. However, UBE required significantly fewer fluoroscopy times (WMD = -0.59, 95% CI: -0.72 to -0.45, P < 0.00001). No significant difference was found in overall complication rates (OR = 0.81, 95% CI: 0.56 to 1.19, P = 0.29). Crucially, no clinically meaningful differences were observed in pain relief (VAS) or functional improvement (ODI) at any postoperative time point.Conclusions While UBE is linked to longer operative duration, greater blood loss, and longer hospitalization than PELD, it offers the advantage of significantly reduced intraoperative radiation exposure. Both techniques demonstrate comparable safety profiles and, most importantly, achieve equivalent and excellent clinical outcomes in pain relief and functional recovery. The choice between UBE and PELD should be individualized based on specific clinical scenarios and surgeon expertise.