Two Minimally Invasive Spine Surgeries Compared: One Eases Pain Faster, the Other Costs Less

Patients with single-segment degenerative lumbar spinal stenosis who underwent unilateral biportal endoscopic decompression (UBED) reported somewhat better early pain relief and function at one month than those treated with percutaneous endoscopic lumbar decompression (PELD), but their hospitalization bills were higher, according to a retrospective comparative study conducted at Jingjiang People’s Hospital Affiliated to Yangzhou University in China. The findings, published in Frontiers in Medicine, offer a clearer picture of the trade-offs between two increasingly popular minimally invasive techniques. The research team reviewed the records of 94 patients operated on between January 2023 and July 2025: 42 treated with UBED and 52 with PELD.

Because the study was retrospective, patients were not randomly assigned to a technique, and the conclusions should be read with that design limitation in mind. The groups were compared on perioperative measures including blood loss, fluoroscopy use, operative duration, time to first walking after surgery, and length of hospital stay, alongside patient-reported outcomes tracking pain, disability, and neurological function. On the technical side, the two procedures showed distinct profiles.

Blood loss was significantly greater in the UBED group, yet surgeons needed significantly fewer fluoroscopy, or real-time X-ray, exposures with that technique. Operative time, time to postoperative ambulation, and length of hospital stay were statistically indistinguishable between the groups, suggesting that neither approach clearly dominated in the operating room or on the ward. Both groups improved substantially from baseline on every patient-reported measure.

Pain intensity measured on the visual analog scale, disability assessed with the Oswestry Disability Index, and neurological function scored by the Japanese Orthopaedic Association scale all showed significant gains at every follow-up point, confirming that both endoscopic decompression methods delivered meaningful relief in this patient group. The early advantage, however, tilted toward UBED. In generalized estimating equation analysis, which accounts for repeated measurements in the same patients, the UBED group reported lower leg-pain scores at one month, lower disability scores at one and six months, and higher neurological function scores at one month, all statistically significant.

The proportion of patients rated with excellent or good outcomes reached 97.6 percent in the UBED group, significantly higher than in the PELD group. Complications told a similar story. The complication rate was 4.76 percent in the UBED group versus 19.23 percent in the PELD group, a significant difference.

The authors did not report a detailed breakdown of complication types in the abstract, so the clinical nature of these events remains an open question for readers weighing the two options. Cost cut the other way. Total hospitalization cost averaged 17,460 RMB in the UBED group compared with 15,820 RMB in the PELD group, a significant difference.

Multivariate regression using a generalized linear model identified surgical approach, length of hospitalization, and intraoperative bleeding as independent predictors of total cost, meaning the technique itself carried a price premium beyond what longer stays or heavier bleeding would explain.

The authors conclude that both UBED and PELD are safe and effective minimally invasive options for single-segment degenerative lumbar spinal stenosis, with UBED offering slightly better early functional outcomes and a numerically lower complication rate at higher cost, while PELD was associated with lower hospitalization cost. As a retrospective comparison of 94 patients at a single Chinese hospital, the study documents real-world differences between the two techniques but cannot establish the causal reasons behind them, and the authors note that the claims expressed are solely their own.

Subject of Research: Comparative clinical efficacy and cost of two endoscopic decompression techniques for degenerative lumbar spinal stenosis

Article Title: Comparison of unilateral biportal endoscopic decompression and percutaneous endoscopic lumbar decompression for single-segment degenerative lumbar spinal stenosis: a retrospective comparative study involving clinical efficacy and cost analysis

Article References: Zhang, Y., Ju, J., & Wu, J. (2026). Comparison of unilateral biportal endoscopic decompression and percutaneous endoscopic lumbar decompression for single-segment degenerative lumbar spinal stenosis: a retrospective comparative study involving clinical efficacy and cost analysis. Frontiers in Medicine, 13, Article 1978780. https://doi.org/10.3389/fmed.2026.1978780

Image Credits: AI Generated

DOI: 10.3389/fmed.2026.1978780

Keywords: lumbar spinal stenosis, endoscopic decompression, UBED, PELD, minimally invasive surgery, spine surgery, patient-reported outcomes, hospitalization cost, complications, retrospective study, orthopedics, Comparison