Far Lateral Lomber Disk Hernisi Tedavisinde Unilateral Biportal Endoskopi ve Mikrocerrahi Sonuçlarının Karşılaştırılması: İki Merkezli Çalışma

Abstract

Amaç: Bu çalışma, iki farklı merkezde deneyimli cerrahlar tarafından uygulanan unilateral biportal endoskopi (UBE) ve mikrocerrahi diskektomi tekniklerinin far lateral lomber disk hernisi (FLLH) tedavisindeki klinik sonuçlarını, cerrahi parametrelerini ve postoperatif analjezik ihtiyaçlarını karşılaştırmayı amaçlamaktadır. Gereç ve Yöntemler: Bu retrospektif iki merkezli çalışmaya, Ağustos 2024-Ağustos 2025 tarihleri arasında FLLH tanısı ile ameliyat edilen 25 hasta dâhil edildi. On üç hastaya merkez 1'de UBE, 12 hastaya merkez 2'de mikrocerrahi diskektomi uygulandı. Demografik özellikler, patoloji seviyesi, ameliyat süresi, intraoperatif komplikasyonlar, hastanede yatış süresi, preoperatif-postoperatif hemoglobin farkı, bel ve bacak vizüel analog skala (VAS) skorları (preoperatif, postoperatif 1. gün, postoperatif 6. hafta ve postoperatif 6. ay) ile Oswestry dizabilite indeksi (ODİ) skorları (preoperatif ve postoperatif 6. ay) retrospektif olarak incelendi. Bulgular: İki grup arasında yaş, vücut kitle indeksi, cinsiyet dağılımı ve patoloji seviyesi açısından anlamlı fark saptanmadı (p>0,05). UBE grubunda ameliyat süresi anlamlı olarak daha uzun (p<0,01), preoperatif-postoperatif hemoglobin farkı anlamlı olarak daha düşük (p<0,001) ve hastanede yatış süresi anlamlı olarak daha kısa (p<0,05) bulundu. Her iki grupta da tüm takip zamanlarında bel VAS, bacak VAS ve ODİ skorlarında anlamlı iyileşme gözlendi (p<0,001); ancak hiçbir zaman noktasında gruplar arası anlamlı fark saptanmadı (p>0,05). VAS ve ODİ skorlarındaki bazale göre değişim iki grup arasında benzerdi. Her iki grupta da dura yırtığı veya intraoperatif komplikasyon görülmedi. Sonuç: UBE ve mikrocerrahi diskektomi, FLLH tedavisinde postoperatif altıncı aya kadar benzer ve olumlu klinik sonuçlar sağlamaktadır. UBE, daha az kan kaybı ve daha kısa hastanede kalış süresi gibi ek avantajlar sunmaktadır. Bununla birlikte, daha uzun ameliyat süresi tekniğin dik öğrenme eğrisini yansıtıyor olabilir. Cerrahi yaklaşım seçimi cerrahın deneyimi ve hastanın beklentileri doğrultusunda belirlenmelidir; daha geniş kapsamlı, uzun dönem prospektif çalışmalara ihtiyaç bulunmaktadır.

Keywords

• Far lateral lomber disk hernisi
• unilateral biportal endoskopi
• mikrocerrahi
• minimal invaziv spinal cerrahi
• klinik sonuçlar

Supporting Institution

Yok

Ethical Statement

Bu çalışmanın etik kurul onayı Tokat Gaziosmanpaşa Üniversitesi Etik Kurulu tarafından verilmiştir (Tarih:17/02/2026, Karar No:26-MOBAEK-062).

Thanks

Bu çalışmanın istatistiki analizinin yapılmasında emeği olan Dr Nazmiye Kurşun'a teşekkür ederiz.

COMPARISON OF CLINICAL OUTCOMES OF UNILATERAL BIPORTAL ENDOSCOPY (UBE) AND MICROSURGİCAL TECHNIQUES IN THE TREATMENT OF FAR LATERAL LUMBAR DISC HERNIATION: A TWO-CENTER RETROSPECTIVE STUDY

Abstract

Objective: This study aimed to compare the clinical outcomes, surgical parameters, and postoperative analgesic requirements of unilateral biportal endoscopy (UBE) discectomy and microsurgical discectomy performed by experienced surgeons at two different centers for the treatment of far lateral lumbar disc herniation (FLLDH). Material and Methods: This retrospective two-center study included 25 patients diagnosed with FLLDH who underwent surgery between August 2024 and August 2025. Thirteen patients underwent UBE at center 1, and 12 patients underwent microsurgical discectomy at center 2. Demographic characteristics, operative level, operative time, intraoperative complications, length of hospital stay, preoperative-topostoperative hemoglobin difference, back and leg visual analog scale (VAS) scores (preoperative, postoperative day 1, postoperative week 6, and postoperative month 6), and oswestry disability index (ODI) scores (preoperative and postoperative month 6) were retrospectively analyzed. Results: No significant differences were observed between the two groups in terms of age, body mass index (BMI), sex distribution, or operative level (p>0.05). The UBE group demonstrated a significantly longer operative time (p<0.01), a significantly lower preoperative-to-postoperative hemoglobin difference (p<0.001), and a significantly shorter length of hospital stay (p<0.05) compared with the microsurgery group. Both groups showed significant improvements in back VAS, leg VAS, and ODI scores across all follow-up time points (p<0.001); however, no significant intergroup differences were detected at any time point (p>0.05). The change in VAS and ODI scores from baseline was comparable between the two groups. No dural tears or other intraoperative complications occurred in either group. Conclusion: Both UBE and microsurgical discectomy yield comparable and favorable clinical outcomes in the treatment of FLLDH up to six months postoperatively. UBE offers the additional advantages of reduced blood loss and shorter hospitalization. However, its longer operative time may reflect the steep learning curve inherent to the technique. The choice of surgical approach should be guided by surgeon experience and patient expectations, and further large-scale, long-term prospective studies are warranted.

Keywords

• Far lateral lumbar disc herniation
• unilateral biportal endoscopy
• microsurgery
• minimally invasive spine surgery
• clinical outcomes

Supporting Institution

None

Ethical Statement

This study was approved by the Tokat Gaziosmanpaşa University Ethics Committee (Date:17/02/2026, Decision No:26-MOBAEK-062).

Thanks

We would like to thank Dr Nazmiye Kurşun for her assitance of statistical analysis of this study

References

1. Suzuki A, Nakamura H. Microendoscopic lumbar posterior decompression surgery for lumbar spinal stenosis: literature review. Medicina (Kaunas). 2022;58(3):384.
2. Durmaz MO, Ezgu MC, Kaplan A, Dogan A. Recurrent lumbar disk herniations: the efficacy of re-operation. J Turk Spinal Surg. 2023;34(3):87-93.
3. Wu J, Guan T, Tian F, Liu X. Comparison of biportal endoscopic and microscopic decompression in treatment of lumbar spinal stenosis: a comparative study protocol. Medicine (Baltimore). 2020;99(30):e21309.
4. Li L, An J, Guo L, et al. Comparison of percutaneous endoscopic lumbar discectomy (PELD) and unilateral biportal endoscopic (UBE) discectomy in the treatment of far lateral lumbar disc herniation (FLLDH): a retrospective study. J Orthop Surg Res. 2025;20(1):510.
5. Kang MS, Hwang JY, Park SM, et al. Comparison of biportal endoscopic and microscopic tubular paraspinal approach for foraminal and extraforaminal lumbar disc herniation. J Neurosurg Spine. 2024;41(4):473-482.
6. Jagoda C, Spanos S, Siu TL. Effectiveness of microscopic tubular discectomy for improved pain and mobility in far lateral lumbar disc herniation: a systematic review. Orthop Surg. 2025;17(12):3289-3301.
7. Chen Y, Gao Z. Progress in far lateral lumbar disc herniation. Spine Surg Relat Res. 2025;10(1):29-35.
8. Meng H, Su N, Lin J, Fei Q. Comparative efficacy of unilateral biportal endoscopy and micro-endoscopic discectomy in the treatment of degenerative lumbar spinal stenosis: a systematic review and meta-analysis. J Orthop Surg Res. 2023;18(1):814.

9. Wang YP, Qin SL, Yang S, Xu YF, Han PF. Efficacy and safety of unilateral biportal endoscopy compared with microscopic decompression in the treatment of lumbar spinal stenosis: a systematic review and updated meta-analysis. Exp Ther Med. 2023;26(1):309.
10. Gurung I, Jones MS, Jugurnauth P, Wafai AM. The importance of "time to surgery" in the management of lumbar disc herniation in patients without progressive neurological deficits. J Spine Surg. 2023;9(1):32-38.
11. Sun Y, Tian D, Chen L, et al. Comparison of unilateral biportal and percutaneous endoscopic discectomy in treating far lateral lumbar disc herniation. Jt Dis Relat Surg. 2026;37(1):16-26.
12. Zhang Z, Yang J, Huang Z, 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.
13. Yuan S, Ma Z, Chen R, et al. Clinical outcomes of unilateral biportal endoscopic discectomy for the treatment of far lateral lumbar disc herniation: a retrospective comparative study. BMC Surg. 2025;25(1):457.
14. Chau AMT, Lerch A, Waser B, et al. Minimally invasive far lateral tubular microdiscectomy: surgical technique and case series of 176 patients. Eur Spine J. 2024;33(11):4385-4391.
15. Özer Mİ, Demirtaş OK, Çulcu Z, Sözer A, Solmaz İ. Unilateral biportal endoscopy versus microscopic discectomy for far-lateral lumbar disc herniations: A retrospective comparative study. Med J West Black Sea. 2025;9(3):354-360.
16. Yang L, Yu T, Jiao J, et al. Comprehensive analysis of UBE-related complications: prevention and management strategies from 4685 patients. Med Sci Monit. 2024;30:e944018.
17. Liu S, Zhao F, Yin CP, et al. Comparing mid-term outcomes and patient satisfaction between percutaneous endoscopic lumbar discectomy and microendoscopic discectomy for foraminal and extraforaminal lumbar disc herniations: a retrospective matched cohort study. Front Surg. 2025;12:1554970.
18. Phan K, Dunn AE, Rao PJ, Mobbs RJ. Far lateral microdiscectomy: a minimally-invasive surgical technique for the treatment of far lateral lumbar disc herniation. J Spine Surg. 2016;2(1):59-63.