Sarcouncil Journal of Medical Series

Abstract: Open microdiscectomy (OM) has remained the surgical gold standard; however, minimally invasive endoscopy has become available to potentially minimize tissue trauma and hasten recovery. A new approach, which is just coming into the picture, is called “Miniaturized Endoscopic Lumbar Discectomy” or “Uniportal Biportal Endoscopic Lumbar Discectomy” (UBELD). The purpose of this paper is to compare and assess the efficacy, safety, and recovery outcomes of UBELD and conventional OM in patients undergoing surgery for a herniated disc in the lumbar spine, the primary outcomes being for pain relief and functional recovery. In addition, a prospective randomized controlled trial was performed with 121 patients with symptomatic lumbar disc herniation who were randomly assigned to UBELD (n=60) or OM (n=61). There were no significant differences between groups in baseline demographics. Primary outcomes were Visual Analog Scale (VAS) scores of back and leg pain and Oswestry Disability Index (ODI) scores. Secondary outcomes included operative time, EBL, hospital stay, complications, recurrence at 12 months, time to return to daily activities, patient satisfaction, and postoperative analgesic consumption. An assessment was conducted preoperatively, and then at 24 hours, 6 weeks, 6 months, and 12 months postoperatively. Additionally, there was a clear clinical improvement in both groups. UBELD was associated with longer operative time (58.4±12.2 vs. 46.2±9.8 min) but significantly reduced estimated blood loss (15.5±5.2 vs. 42.8±12.4 mL), shorter hospital stay (22.4±4.5 vs. 44.8±10.2 hours), and markedly lower analgesic consumption at 24 hours (15.2±5.5 vs. 35.8±8.2 MME). At 24 hours, pain was better with UBELD both for back pain (VAS: 2.8±0.8 vs. 4.2±1.04) and for leg pain (2.1±0.7 vs. 3.5±0.9) and remained better at 6 weeks. At 6 weeks, functional recovery (ODI) was improved in UBELD (18.2±4.5 vs. 20.1±4.9); these differences between groups became less pronounced at 6 months. Complication rates (5.0% vs. 8.2%) and 12-month recurrence rates (3.3% vs. 4.9%) were comparable. UBELD had a significant impact on early return to daily life, with no differences in patient satisfaction, yet high satisfaction rates in both groups (12.4±3.5 vs. 22.6±5.2 days). In conclusion, UBELD is considered as a safe and effective minimally invasive option for treating LDHs that eliminates the need for open microdiscectomy. UBELD is superior in perioperative parameters, early postoperative pain control and analgesic requirement, shortened hospital stay, and rapid return to daily activities, while long-term pain relief and functional outcome are comparable. The results confirm UBELD as a good alternative for certain patients who want to achieve a faster recovery but at the same safety level as regular LED.