Is percutaneous endoscopic lumbar discectomy necessary for learning the unilateral biportal endoscopy technique?

Objective: This study aims to investigate the effect of prior percutaneous endoscopic lumbar discectomy (PELD) surgical experience on the learning curve of the unilateral biportal endoscopy (UBE) technique. Methods: A total of 200 patients undergoing single-segment UBE surgery were enrolled. The procedures were performed by four surgeons, who were divided into two groups based on whether they had prior PELD experience (Group A: with; Group B: without). Proficiency in UBE technique was defined as a surgery time of less than 80 min. The cumulative sum analysis (CUSUM) method was used to analyze each surgeon's learning curve. Clinical efficacy was evaluated using patient-reported outcomes (PROs) after surgery: Modified Macnab, VAS-leg, VAS-back, and ODI scores. Follow-up information was obtained 12 months postoperatively. Results: The number of cases required for Group A surgeons to achieve proficiency were 17 and 18, significantly fewer than the 25 and 27 cases for Group B surgeons. No significant differences in clinical outcomes were observed between the two groups. The complication rates for Group A and Group B were 5 and 14, respectively. Conclusion: Prior PELD surgical experience facilitates learning the UBE technique. This experience further aids in shortening surgical times, lowering complication rates, and decreasing the need for reoperation.