Percutaneous transforaminal endoscopic discectomy vs. unilateral biportal endoscopy for far lateral lumbar disc herniation: a retrospective comparative study

Objective To compare the early clinical efficacy, perioperative parameters, and safety profiles of percutaneous transforaminal endoscopic discectomy (PTED) and unilateral biportal endoscopic (UBE) discectomy in treating single-level far lateral lumbar disc herniation (FLLDH). Methods This retrospective cohort study analyzed 81 patients with FLLDH treated between January 2021 and June 2024. Patients were allocated to the PTED group ( n  = 38) or the UBE group ( n  = 43) based on the surgical technique received. Perioperative indicators (operative time, incision length, blood loss, hospital stay) and clinical outcomes—assessed by Visual Analogue Scale (VAS) for back/leg pain and the Oswestry Disability Index (ODI) preoperatively and at 1, 3, 6, and 12 months postoperatively—were compared. Statistical analyses included independent samples t-tests, chi-square tests, and repeated-measures ANOVA. Results All patients completed 12-month follow-up. The two groups were comparable at baseline ( P  > 0.05). The PTED group demonstrated significantly shorter operative time (62.4 ± 8.7 vs. 105.3 ± 14.1 min, P  < 0.001), smaller incision length (7.8 ± 0.9 vs. 24.6 ± 4.2 mm, P  < 0.001), less intraoperative blood loss (18.5 ± 4.3 vs. 68.2 ± 10.5 mL, P  < 0.001), and shorter hospital stay (4.8 ± 1.1 vs. 5.9 ± 1.7 days, P  = 0.002). Both groups showed significant and sustained improvement in VAS and ODI scores postoperatively ( P  < 0.05). At 1 month, PTED was associated with lower back pain VAS but slightly higher leg pain VAS and ODI compared to UBE ( P  < 0.05). From 3 months onward, no significant inter-group differences were observed in any clinical scores ( P  > 0.05). Repeated-measures ANOVA indicated a different improvement trajectory for back pain between the groups (interaction P  = 0.024). Conclusion Both PTED and UBE are effective minimally invasive techniques for FLLDH, offering comparable and excellent mid-term clinical outcomes. PTED offers advantages in reduced surgical trauma and faster early recovery, whereas UBE provides superior endoscopic visualization. The choice of technique can be individualized based on patient characteristics and surgical expertise.