Comparing Unilateral Biportal Endoscopic Discectomy Versus Microdiscectomy for Lumbar Disc Herniation: A Systematic Review and Meta-Analysis

Abstract

Study Design: This study is a meta-analysis of randomized controlled trials (RCTs) and observational studies. Objective: Lumbar disc herniation (LDH) often requires surgery, with microdiscectomy (MD) being common. This study compares Unilateral Biportal Endoscopic Discectomy (UBED) to conventional and tubular MD for LDH treatment. Methods: PubMed, Cochrane Central, and ScienceDirect were searched up to May 2025. Mean differences (MDs) and risk ratios (RRs) were pooled with a random effects model using Review Manager. Quality was assessed using the Cochrane risk of bias tool and the Newcastle-Ottawa Scale. Publication bias was evaluated with funnel plots and Egger’s regression test. Results: Thirteen studies (11 observational studies and 2 RCTs), pooling 1369 patients, were included. UBED was associated with decreased 1-3 days post-operative (MD: −0.81; 95% CI: [−1.48, −0.14]; P = 0.02) and 12 months post-operative (MD: −0.37; 95% CI: [−0.74, −0.01]; P = 0.04) VAS back pain scores, 12 months post-operative ODI scores (MD: −1.32; 95% CI: [−2.44, −0.19]; P = 0.02), estimated blood loss (MD: −74.42; 95% CI: [−114.11, −34.73]; P = 0.0002), and hospital stay (MD: −1.81; 95% CI: [−2.99, −0.63]; P = 0.003) compared to conventional MD although the operative time was high (MD: 9.07; 95% CI: [1.66, 16.48]; P = 0.02). Concurrently, the 12 months post-operative VAS back pain score (MD: −0.42; 95% CI: [−1.40, 0.56]; P = 0.40) and ODI score (MD: 1.39; 95% CI: [−2.80, 5.58]; P = 0.52) along with the operative time (MD: 21.80; 95% CI: [−26.31, 69.92]; P = 0.37) and hospital stay (MD: 0.02; 95% CI: [−0.30, 0.33]; P = 0.92) were comparable between the UBED and tubular MD. The VAS leg pain scores were comparable between UBED and both conventional and tubular MD. Conclusion: UBED may be associated with reduced early and long-term back pain, disability, blood loss, and hospital stays compared to conventional MD, but has longer surgery times, with comparable outcomes to tubular MD. More large-scale RCTs are required to validate these results.