Effectiveness comparison of percutaneous endoscopic transforaminal discectomy and unilateral biportal endoscopy for far lateral lumbar disc herniation_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

ZHANG Jijiang ¹ , FENG Bo ² , XU Zengmao ¹ , TIAN Lin ¹ , DAI Guohua ¹ , WANG Kaiwei ¹ ,  HU Peng ¹

1. Department of Spinal Surgery, Binzhou Medical University Hospital, Binzhou Shandong, 256603, P. R. China;
2. Department of Neurology, Binzhou Medical University Hospital, Binzhou Shandong, 256603, P. R. China;

Corresponding?author：

HU Peng, Email: qyhupeng@163.com

Keywords：

Transforaminal endoscopy; unilateral biportal endoscopy; far lateral lumbar disc herniation; minimally invasive treatment

DOI：

10.7507/1002-1892.202508082

Video：

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Objective To compare the effectiveness of percutaneous transforaminal endoscopic discectomy (PTED) and unilateral biportal endoscopy (UBE) discectomy in the treatment of far lateral lumbar disc herniation (FLLDH). Methods A retrospective analysis was conducted on the clinical data of 60 patients with FLLDH, who were admitted between September 2021 and September 2024 and met the selection criteria, including 30 cases treated with PTED and 30 cases with UBE discectomy. There was no significant difference in baseline data between the two groups (P>0.05), such as gender, age, body mass index, responsible segment, preoperative visual analogue scale (VAS) scores for low back/leg pain, and modified Oswestry Disability Index (ODI). The operation time, incision length, intraoperative blood loss, and length of hospital stay in two groups were recorded. The VAS score was used to evaluate the severity of low back and leg pain, and the ODI was employed to assess the spinal functional status. X-ray films combined with CT three-dimensional reconstruction and MRI were performed to confirm the nerve decompression effect and soft tissue repair status. Results All patients successfully underwent operation. In the PTED group, 1 patient experienced intolerable lower extremity pain during the procedure, which was managed with potent analgesics allowing the operation to proceed uneventfully. In the UBE group, 1 patient developed peritoneal effusion postoperatively and required peritoneal puncture drainage. All incisions healed by first intention. The UBE group demonstrated significantly longer operation time and incision length, and more intraoperative blood loss compared to the PTED group (P<0.05). All patients were followed up for 12 months. After operation, both groups showed significant reductions in VAS scores for low back and leg pain as well as ODI compared to preoperative measurements, with continuous improvement over time. There were significant differences between different time points (P<0.05) in both groups. The VAS score for low back pain in the UBE group was significantly higher than that in the PTED group at 3 days after operation (P<0.05); there was no significantly between the two groups in other outcome indicators (P>0.05). Radiological re-examinations showed that both groups had limited resection of articular processes, adequate spinal canal decompression, good nerve root release, and satisfactory lumbar stability. No patients experienced incomplete decompression or required reoperation during follow-up. Conclusion Both PTED and UBE are effective minimally invasive approaches for FLLDH with confirmed short-term effectiveness. PTED offers advantages in reduced trauma and faster recovery, whereas UBE provides superior endoscopic visualization with lower nerve root injury risk.

1.	Abdullah AF, Ditto EW, Byrd EB, et al. Extreme-lateral lumbar disc herniations. Clinical syndrome and special problems of diagnosis. J Neurosurg, 1974, 41(2): 229-234.
2.	Berra LV, Di Rita A, Longhitano F, et al. Far lateral lumbar disc herniation part 1: Imaging, neurophysiology and clinical features. World J Orthop, 2021, 12(12): 961-969.
3.	Reulen HJ, Müller A, Ebeling U. Microsurgical anatomy of the lateral approach to extraforaminal lumbar disc herniations. Neurosurgery, 1996, 39(2): 345-350.
4.	Yeung AT, Tsou PM. Posterolateral endoscopic excision for lumbar disc herniation: Surgical technique, outcome, and complications in 307 consecutive cases. Spine (Phila Pa 1976), 2002, 27(7): 722-731.
5.	Hoogland T, Schubert M, Miklitz B, et al. Transforaminal posterolateral endoscopic discectomy with or without the combination of a low-dose chymopapain: a prospective randomized study in 280 consecutive cases. Spine (Phila Pa 1976), 2006, 31(24): E890-E897.
6.	Choi CM. Biportal endoscopic spine surgery (BESS): considering merits and pitfalls. J Spine Surg, 2020, 6(2): 457-465.
7.	Zheng C, Wu F, Cai L. Transforaminal percutaneous endoscopic discectomy in the treatment of far-lateral lumbar disc herniations in children. Int Orthop, 2016, 40(6): 1099-1102.
8.	Fankhauser H, de Tribolet N. Extreme lateral lumbar disc herniation. Br J Neurosurg, 1987, 1(1): 111-129.
9.	Ahn Y, Yoo BR, Jung JM. The irony of the transforaminal approach: A comparative cohort study of transforaminal endoscopic lumbar discectomy for foraminal versus paramedian lumbar disc herniation. Medicine (Baltimore), 2021, 100(40): e27412. doi: 10.1097/MD.0000000000027412.
10.	Garg B, Nagraja UB, Jayaswal A. Microendoscopic versus open discectomy for lumbar disc herniation: a prospective randomised study. J Orthop Surg (Hong Kong), 2011, 19(1): 30-34.
11.	劉豐平, 趙紅衛, 陳海丹, 等. TESSYS椎間孔鏡治療腰椎間盤突出癥的學習曲線及經驗. 中國矯形外科雜志, 2016, 24(3): 235-241.
12.	Xu J, Wang D, Liu J, et al. Learning curve and complications of unilateral biportal endoscopy: cumulative sum and risk-adjusted cumulative sum analysis. Neurospine, 2022, 19(3): 792-804.
13.	張先鵬, 何澤偉, 樓鈺晗, 等. 單側雙通道內鏡椎旁入路治療極外側型腰椎間盤突出癥的臨床療效. 中國內鏡雜志, 2023, 29(12): 1-7.
14.	Kim J, Choi D. Unilateral biportal endoscopic decompression by 30 degrees endoscopy in lumbar spinal stenosis: Technical note and preliminary report. J Orthop, 2018, 15(2): 366-371.
15.	Hwa Eum J, Hwa Heo D, Son S K, et al. Percutaneous biportal endoscopic decompression for lumbar spinal stenosis: a technical note and preliminary clinical results. J Neurosurg Spine, 2016, 24(4): 602-607.
16.	王二, 王龍, 閔繼康, 等. 單側雙通道內鏡與經皮椎間孔鏡技術治療極外側型腰椎間盤突出癥的臨床療效對比. 中國內鏡雜志, 2025, 31(6): 9-16.
17.	Li M, Yang H, Yang Q. Full-endoscopic technique discectomy versus microendoscopic discectomy for the surgical treatment of lumbar disc herniation. Pain Physician, 2015, 18(4): 359-363.
18.	Choi KC, Park CK. Percutaneous endoscopic lumbar discectomy for L₅-S₁ disc herniation: Consideration of the relation between the iliac crest and L₅-S₁ disc. Pain Physician, 2016, 19(2): E301-E308.
19.	Li P, Yang F, Chen Y, et al. Percutaneous transforaminal endoscopic discectomy for different types of lumbar disc herniation: A retrospective study. J Int Med Res, 2021, 49(10): 3000605211055045. doi: 10.1177/03000605211055045.
20.	Pan M, Li Q, Li S, et al. Percutaneous endoscopic lumbar discectomy: indications and complications. Pain Physician, 2020, 23(1): 49-56.
21.	Hwang JS, Lee SH, Jeong D, et al. Far-lateral transforaminal unilateral biportal endoscopic lumbar discectomy for upper lumbar disc herniations. Neurospine, 2025, 22(1): 14-27.
22.	Zhiqiang Z, Jiandong Y, Zhi H, et al. Clinical efficacy of biportal versus uniportal endoscopic discectomy for far lateral lumbar disc herniation: a retrospective study analysis. World Neurosurg, 2025, 197: 123788. doi: 10.1016/j.wneu.2025.123788.
23.	Chen Z, Zhang L, Dong J, et al. Percutaneous transforaminal endoscopic discectomy compared with microendoscopic discectomy for lumbar disc herniation: 1-year results of an ongoing randomized controlled trial. J Neurosurg Spine, 2018, 28(3): 300-310.

1. Abdullah AF, Ditto EW, Byrd EB, et al. Extreme-lateral lumbar disc herniations. Clinical syndrome and special problems of diagnosis. J Neurosurg, 1974, 41(2): 229-234.
2. Berra LV, Di Rita A, Longhitano F, et al. Far lateral lumbar disc herniation part 1: Imaging, neurophysiology and clinical features. World J Orthop, 2021, 12(12): 961-969.
3. Reulen HJ, Müller A, Ebeling U. Microsurgical anatomy of the lateral approach to extraforaminal lumbar disc herniations. Neurosurgery, 1996, 39(2): 345-350.
4. Yeung AT, Tsou PM. Posterolateral endoscopic excision for lumbar disc herniation: Surgical technique, outcome, and complications in 307 consecutive cases. Spine (Phila Pa 1976), 2002, 27(7): 722-731.
5. Hoogland T, Schubert M, Miklitz B, et al. Transforaminal posterolateral endoscopic discectomy with or without the combination of a low-dose chymopapain: a prospective randomized study in 280 consecutive cases. Spine (Phila Pa 1976), 2006, 31(24): E890-E897.
6. Choi CM. Biportal endoscopic spine surgery (BESS): considering merits and pitfalls. J Spine Surg, 2020, 6(2): 457-465.
7. Zheng C, Wu F, Cai L. Transforaminal percutaneous endoscopic discectomy in the treatment of far-lateral lumbar disc herniations in children. Int Orthop, 2016, 40(6): 1099-1102.
8. Fankhauser H, de Tribolet N. Extreme lateral lumbar disc herniation. Br J Neurosurg, 1987, 1(1): 111-129.
9. Ahn Y, Yoo BR, Jung JM. The irony of the transforaminal approach: A comparative cohort study of transforaminal endoscopic lumbar discectomy for foraminal versus paramedian lumbar disc herniation. Medicine (Baltimore), 2021, 100(40): e27412. doi: 10.1097/MD.0000000000027412.
10. Garg B, Nagraja UB, Jayaswal A. Microendoscopic versus open discectomy for lumbar disc herniation: a prospective randomised study. J Orthop Surg (Hong Kong), 2011, 19(1): 30-34.
11. 劉豐平, 趙紅衛, 陳海丹, 等. TESSYS椎間孔鏡治療腰椎間盤突出癥的學習曲線及經驗. 中國矯形外科雜志, 2016, 24(3): 235-241.
12. Xu J, Wang D, Liu J, et al. Learning curve and complications of unilateral biportal endoscopy: cumulative sum and risk-adjusted cumulative sum analysis. Neurospine, 2022, 19(3): 792-804.
13. 張先鵬, 何澤偉, 樓鈺晗, 等. 單側雙通道內鏡椎旁入路治療極外側型腰椎間盤突出癥的臨床療效. 中國內鏡雜志, 2023, 29(12): 1-7.
14. Kim J, Choi D. Unilateral biportal endoscopic decompression by 30 degrees endoscopy in lumbar spinal stenosis: Technical note and preliminary report. J Orthop, 2018, 15(2): 366-371.
15. Hwa Eum J, Hwa Heo D, Son S K, et al. Percutaneous biportal endoscopic decompression for lumbar spinal stenosis: a technical note and preliminary clinical results. J Neurosurg Spine, 2016, 24(4): 602-607.
16. 王二, 王龍, 閔繼康, 等. 單側雙通道內鏡與經皮椎間孔鏡技術治療極外側型腰椎間盤突出癥的臨床療效對比. 中國內鏡雜志, 2025, 31(6): 9-16.
17. Li M, Yang H, Yang Q. Full-endoscopic technique discectomy versus microendoscopic discectomy for the surgical treatment of lumbar disc herniation. Pain Physician, 2015, 18(4): 359-363.
18. Choi KC, Park CK. Percutaneous endoscopic lumbar discectomy for L₅-S₁ disc herniation: Consideration of the relation between the iliac crest and L₅-S₁ disc. Pain Physician, 2016, 19(2): E301-E308.
19. Li P, Yang F, Chen Y, et al. Percutaneous transforaminal endoscopic discectomy for different types of lumbar disc herniation: A retrospective study. J Int Med Res, 2021, 49(10): 3000605211055045. doi: 10.1177/03000605211055045.
20. Pan M, Li Q, Li S, et al. Percutaneous endoscopic lumbar discectomy: indications and complications. Pain Physician, 2020, 23(1): 49-56.
21. Hwang JS, Lee SH, Jeong D, et al. Far-lateral transforaminal unilateral biportal endoscopic lumbar discectomy for upper lumbar disc herniations. Neurospine, 2025, 22(1): 14-27.
22. Zhiqiang Z, Jiandong Y, Zhi H, et al. Clinical efficacy of biportal versus uniportal endoscopic discectomy for far lateral lumbar disc herniation: a retrospective study analysis. World Neurosurg, 2025, 197: 123788. doi: 10.1016/j.wneu.2025.123788.
23. Chen Z, Zhang L, Dong J, et al. Percutaneous transforaminal endoscopic discectomy compared with microendoscopic discectomy for lumbar disc herniation: 1-year results of an ongoing randomized controlled trial. J Neurosurg Spine, 2018, 28(3): 300-310.

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