Unilateral Biportal Endoscopic Discectomy versus Percutaneous Endoscopic Lumbar Discectomy in the Treatment of Lumbar Disc Herniation Linked with Posterior Ring Apophysis Separation: A Retrospective Study

Posterior ring apophysis separation (PRAS) associated with lumbar disc herniation (LDH) is a relatively rare form of disc herniation. This study aims to evaluate the clinical effectiveness of unilateral biportal endoscopic discectomy (UBE) and percutaneous endoscopic lumbar discectomy (PELD) in the treatment of PRAS with LDH. We enrolled 41 patients who met the inclusion criteria to undergo either UBE (15 cases) or PELD (26 cases) between October 2022 and October 2023. Perioperative evaluation parameters included mean operative time, hemoglobin (Hb) loss, length of stay (LOS), and postoperative complications. Outcomes were assessed at admission, as well as at 1, 3, and 6 months postsurgery using the Visual Analog Scale (VAS) and the Oswestry Disability Index (ODI). Additionally, we evaluated the results according to the modified MacNab criteria. Both groups demonstrated improvements in postoperative VAS and ODI scores. However, there were no significant differences between the 2 groups in VAS and ODI scores before surgery, or at 1, 3, and 6 months postsurgery. Additionally, no notable differences were observed in the modified MacNab criteria. The UBE group experienced greater Hb loss, longer mean operative time, and increased LOS compared to the PELD group. Furthermore, 2 patients in the PELD group reported recurrence, while one patient in the UBE group experienced a dural tear. UBE and PELD possess strong clinical effectiveness for treating PRAS with LDH. Although the UBE group had a longer mean operative time and LOS, with more Hb loss, the UBE group had a lower recurrence rate. Therefore, UBE remains safe and innovative for the treatment of PRAS with LDH.