Biomechanical Comparison of Unilateral Biportal Endoscopy and Percutaneous Endoscopic Lumbar Discectomy Using a Finite Element Model.
- 1Department of Neurosurgery, Spine and Spinal Cord Institute Severance Hospital, Yonsei University College of Medicine Seoul Korea.
- 2Department of Neurosurgery The Spine and Spinal Cord Institute, Gangnam Severance Hospital, Yonsei University College of Medicine Seoul Korea.
Abstract
Background
Lumbar disc herniation (LDH) remains a significant cause of back and leg pain and disability worldwide, necessitating effective surgical intervention when conservative treatments fail.Objective
This study aims to compare the biomechanical properties of unilateral biportal endoscopy (UBE) discectomy and percutaneous endoscopic lumbar discectomy (PELD) with those of open microscopic discectomy (OD) for treating LDH.Methods
Finite element analysis (FEA) was used to evaluate and compare postoperative biomechanical outcomes, focusing on stress distribution, spinal segment flexibility, and postoperative structural integrity. A single patient-specific L4-L5 finite element model was constructed from a high-resolution CT dataset and modified to simulate intact, OD, UBE, and PELD conditions.Results
All three surgical models showed increased range of motion relative to the intact model, with the largest changes in the OD model. The greatest increase occurred in extension (OD, +12.4%; UBE, +4.6%; PELD, +3.5%). Peak von Mises stress in the nucleus pulposus and annulus fibrosus increased across all models, with the greatest increases in OD and the least in PELD. During extension, facet stress increased by 60.0% in the OD model and 14.4% in the UBE model, whereas the PELD model remained essentially unchanged (-1.6%).Conclusion
Within this single patient-specific model, models with less posterior osteoligamentous resection showed smaller deviations in range of motion and lower peak stresses. These findings suggest an association between the extent of structural resection and immediate postoperative biomechanical changes, rather than an inherent superiority of any particular technique. The results are model-specific and hypothesis-generating, and require validation across multiple patient-specific models and clinical studies.
Related
- Unilateral Biportal Endoscopy Versus Percutaneous Endoscopic Interlaminar Discectomy for Highly Migrated Lumbar Disc Herniation: A Retrospective Comparative Study With Quantitative MRI-Based Decompression Analysis.
- How reliable is percutaneous transforaminal endoscopic discectomy during the learning curve? A comparison of outcomes with microsurgical discectomy experiences
- 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
- Comparison Between Interlaminar and Transforaminal Endoscopic Lumbar Discectomy for Sciatic Scoliosis Secondary to Lumbar Disc Herniation: A Retrospective Study With a Minimum 1 Year Follow‐Up
- Clinical efficacy of Delta large-channel endoscopy versus percutaneous endoscopic lumbar discectomy in treating far lateral lumbar disc herniation: a retrospective study.
BibTeX
@article{lee2026biomechanical,
title = {{Biomechanical Comparison of Unilateral Biportal Endoscopy and Percutaneous Endoscopic Lumbar Discectomy Using a Finite Element Model.}},
author = {Chang Kyu Lee and Bong Ju Moon and Seong Yi and Yoon Ha and Keung Nyun Kim and Dong Ah Shin},
journal = {JOR spine},
year = {2026},
month = oct,
doi = {10.1002/jsp2.70222},
url = {https://europepmc.org/article/MED/42948361},
note = {CC BY},
}
RIS
TY - JOUR
TI - Biomechanical Comparison of Unilateral Biportal Endoscopy and Percutaneous Endoscopic Lumbar Discectomy Using a Finite Element Model.
AU - Chang Kyu Lee
AU - Bong Ju Moon
AU - Seong Yi
AU - Yoon Ha
AU - Keung Nyun Kim
AU - Dong Ah Shin
PY - 2026
DA - 2026/10/27
JO - JOR spine
DO - 10.1002/jsp2.70222
UR - https://europepmc.org/article/MED/42948361
AB - Background Lumbar disc herniation (LDH) remains a significant cause of back and leg pain and disability worldwide, necessitating effective surgical intervention when conservative treatments fail.Objective This study aims to compare the biomechanical properties of unilateral biportal endoscopy (UBE) discectomy and percutaneous endoscopic lumbar discectomy (PELD) with those of open microscopic discectomy (OD) for treating LDH.Methods Finite element analysis (FEA) was used to evaluate and compare postoperative biomechanical outcomes, focusing on stress distribution, spinal segment flexibility, and postoperative structural integrity. A single patient-specific L4-L5 finite element model was constructed from a high-resolution CT dataset and modified to simulate intact, OD, UBE, and PELD conditions.Results All three surgical models showed increased range of motion relative to the intact model, with the largest changes in the OD model. The greatest increase occurred in extension (OD, +12.4%; UBE, +4.6%; PELD, +3.5%). Peak von Mises stress in the nucleus pulposus and annulus fibrosus increased across all models, with the greatest increases in OD and the least in PELD. During extension, facet stress increased by 60.0% in the OD model and 14.4% in the UBE model, whereas the PELD model remained essentially unchanged (-1.6%).Conclusion Within this single patient-specific model, models with less posterior osteoligamentous resection showed smaller deviations in range of motion and lower peak stresses. These findings suggest an association between the extent of structural resection and immediate postoperative biomechanical changes, rather than an inherent superiority of any particular technique. The results are model-specific and hypothesis-generating, and require validation across multiple patient-specific models and clinical studies.
SN - 2572-1143
ER -