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.
