European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society · 2026
Comparative outcomes of uni-portal non-coaxial spinal endoscopic surgery and unilateral biportal spinal endoscopy for far-lateral lumbar disc herniation involving the foraminal region: a retrospective study.
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Zhou Shihao, Zhao Hongshun, Guo Tianluo, Hu Peiran, Xu Zhihua, Sun Junhao, Xu Xiaowan, Ma Shuai, Zhu Chao, Song En, Jiancuo A
Аннотация
OBJECTIVE: To compare the safety and efficacy of unilateral biportal endoscopic lumbar discectomy (UBE) and uniportal non-coaxial spinal endoscopic surgery (UNSES) in patients with far-lateral lumbar disc herniation (FLLDH) involving the foraminal region.
METHODS: This retrospective study enrolled 102 patients with foraminal-region FLLDH who were treated between January 2022 and October 2024. Among them, 43 patients underwent UNSES and 59 underwent UBE. Perioperative variables were recorded. Back and leg pain visual analog scale (VAS) scores, Oswestry Disability Index (ODI) scores, Japanese Orthopaedic Association (JOA) scores, and modified Macnab outcomes were compared between groups preoperatively and at each postoperative follow-up. Preoperative and postoperative day 1 computed tomography images were analyzed to assess changes in foraminal area.
RESULTS: All procedures were completed successfully. Baseline characteristics did not differ significantly between the two groups. Operative time was significantly shorter in the UNSES group than in the UBE group (P < 0.001). In both groups, VAS scores for back and leg pain and ODI scores improved significantly from baseline at all postoperative follow-up time points (all P < 0.05). However, these outcomes did not differ significantly between the groups at any postoperative follow-up time point.On postoperative day 3, the JOA score was significantly higher in the UNSES group than in the UBE group (P = 0.031). JOA scores did not differ significantly between the groups at 3, 6, or 12 months after surgery. Imaging analysis showed that the foraminal area increased postoperatively in both groups. On postoperative day 1, the foraminal area was significantly greater in the UNSES group than in the UBE group (P = 0.017). Surgical-site infection occurred in one patient in the UBE group and two patients in the UNSES group. Neurologic symptoms or signs were observed in four patients in the UBE group and three patients in the UNSES group. These manifestations gradually resolved during follow-up after symptomatic treatment. Recurrence was observed in one patient in the UBE group and two patients in the UNSES group. At the final follow-up, clinical outcomes assessed using the modified Macnab criteria did not differ significantly between the groups.
CONCLUSION: Both UNSES and UBE resulted in significant pain relief and functional improvement in patients with foraminal-region FLLDH. Compared with UBE, UNSES was associated with shorter operative time and greater foraminal enlargement. However, long-term clinical outcomes were comparable between the two techniques.
METHODS: This retrospective study enrolled 102 patients with foraminal-region FLLDH who were treated between January 2022 and October 2024. Among them, 43 patients underwent UNSES and 59 underwent UBE. Perioperative variables were recorded. Back and leg pain visual analog scale (VAS) scores, Oswestry Disability Index (ODI) scores, Japanese Orthopaedic Association (JOA) scores, and modified Macnab outcomes were compared between groups preoperatively and at each postoperative follow-up. Preoperative and postoperative day 1 computed tomography images were analyzed to assess changes in foraminal area.
RESULTS: All procedures were completed successfully. Baseline characteristics did not differ significantly between the two groups. Operative time was significantly shorter in the UNSES group than in the UBE group (P < 0.001). In both groups, VAS scores for back and leg pain and ODI scores improved significantly from baseline at all postoperative follow-up time points (all P < 0.05). However, these outcomes did not differ significantly between the groups at any postoperative follow-up time point.On postoperative day 3, the JOA score was significantly higher in the UNSES group than in the UBE group (P = 0.031). JOA scores did not differ significantly between the groups at 3, 6, or 12 months after surgery. Imaging analysis showed that the foraminal area increased postoperatively in both groups. On postoperative day 1, the foraminal area was significantly greater in the UNSES group than in the UBE group (P = 0.017). Surgical-site infection occurred in one patient in the UBE group and two patients in the UNSES group. Neurologic symptoms or signs were observed in four patients in the UBE group and three patients in the UNSES group. These manifestations gradually resolved during follow-up after symptomatic treatment. Recurrence was observed in one patient in the UBE group and two patients in the UNSES group. At the final follow-up, clinical outcomes assessed using the modified Macnab criteria did not differ significantly between the groups.
CONCLUSION: Both UNSES and UBE resulted in significant pain relief and functional improvement in patients with foraminal-region FLLDH. Compared with UBE, UNSES was associated with shorter operative time and greater foraminal enlargement. However, long-term clinical outcomes were comparable between the two techniques.