The effect of UBE and PELD surgery on pain, lumbar function, and imaging indicators in patients with lumbar disc herniation combined with lumbar spinal stenosis

doi:10.3969/j.issn.1674-3245.2025.03.041

Abstract：Objective To analyze the effects of unilateral biportal endoscopic lumbar discectomy (UBE) and percutaneous endoscopic lumbar discectomy (PELD) on pain, lumbar function, and imaging indicators in patients with lumbar disc herniation (LDH) combined with lumbar spinal stenosis. Methods A total of 105 patients with LDH combined with lumbar spinal stenosis treated at Beijing Daxing District People's Hospital from June 2022 to June 2023 were selected. According to the patients' surgical preferences, they were divided into a control group (46 cases) and an observation group (59 cases). Three patients in the control group were lost to follow-up, and finally 43 cases were included; five patients in the observation group were lost to follow-up, and finally 54 cases were included. The control group received PELD treatment, while the observation group received UBE treatment. Both groups were followed up for 12 months postoperatively. The efficacy after 12 months was compared between the two groups; surgical indicators were compared; pain and lumbar function scores before and 1 and 12 months after surgery were compared; imaging indicators before and 12 months after surgery were compared; complications within 12 months of follow-up were recorded. Results There was no statistically significant difference in the excellent and good rate between the two groups (90.74% vs. 86.05%) (χ²=0.524, P>0.05). Compared with the control group, the observation group had a longer incision length, higher intraoperative blood loss, fewer fluoroscopy times, and shorter operation time, with statistically significant differences (t=9.718, 19.499, 16.799, 7.861, P<0.05). Compared with preoperative values, both groups showed a decreasing trend in visual analog scale (VAS) and Oswestry Disability Index (ODI) scores, and an increasing trend in Japanese Orthopaedic Association (JOA) scores at 1 and 12 months postoperatively. However, there was no statistically significant difference in VAS, ODI, or JOA scores between the two groups at 1 and 12 months postoperatively (P>0.05). Compared with preoperative values, the dural sac cross-sectional area increased in both groups at 12 months postoperatively, with the observation group showing a greater increase than the control group (t=5.750, P<0.05); intervertebral space height and spinal canal occupation rate decreased in both groups, with the observation group showing a lower decrease than the control group (t=5.769, 2.354, P<0.05). There was no statistically significant difference in the overall complication rate within 12 months of follow-up between the two groups (χ² corrected=0.510, P>0.05). Conclusion Both UBE and PELD treatments for LDH combined with lumbar spinal stenosis have good efficacy and safety. Both surgeries can relieve patient pain and improve lumbar function. UBE has advantages in reducing fluoroscopy times and shortening operation time, as well as better imaging results, while PELD has the advantage of smaller surgical trauma. Clinicians can choose the appropriate surgical treatment based on the patient's actual condition.