Conventional microdiscectomy versus unilateral biportal endoscopy for lumbar disc herniation during the learning curve: Propensity-score matched analysis of clinical results.

Introduction: Endoscopy approaches to lumbar disc herniation (LDH) surgery, particularly unilateral biportal endoscopy (UBE), have gained in popularity because of their minimally invasive nature and potential for good recovery. However, comparisons with conventional microdiscectomy, especially during learning curve, are limited. Research question: This study compared clinical outcomes, safety, and resource use between UBE and conventional microdiscectomy for LDH during the learning curve of UBE implementation. Material and methods: This retrospective, single-center study analyzed data for 363 patients who underwent LDH surgery from January 2022 to September 2023. After 1:1 propensity score matching, 302 patients (151 per group) were included. Patients were evaluated preoperatively and at 1, 3, and 12 months postoperatively with the Oswestry Disability Index (ODI), lumbar and radicular pain scales, and satisfaction surveys. Complications, reoperation rates, operative time, hospitalization, and disposable costs were also analyzed. Results: Both groups experienced significant improvement in ODI and pain scores at all time points, without significant differences between groups. Satisfaction and return-to-work rates were similarly high in both groups. Complication and reoperation rates did not differ significantly. The UBE group featured longer operative times (57 vs. 44 min) and higher disposable costs (€261 vs. €91) than conventional microdiscectomy but a higher outpatient discharge rate (20.5 % vs. 9.3 %). Discussion and conclusion: UBE is as effective and safe as conventional microdiscectomy for LDH, even during the learning curve. It allows for early adoption without compromising patient outcomes and may offer advantages in outpatient feasibility, despite longer operating times and higher procedural costs.