TITLE:
Minimally Invasive Surgical Techniques for Lumbar Disc Herniation: A Comparative Review of PELD, UBE, PEID and MED
AUTHORS:
Fatima, Arjun Sinkemani, Shuang Zhang
KEYWORDS:
Lumbar Disc Herniation, Minimally Invasive Spine Surgery, PELD, UBE, PEID, MED, Endoscopic Discectomy, Surgical Indication, Clinical Outcomes
JOURNAL NAME:
Open Journal of Modern Neurosurgery,
Vol.16 No.4,
September
30,
2026
ABSTRACT: Lumbar Disc Herniation (LDH) ranks among the most prevalent degenerative spinal disorders responsible for refractory low back pain and radicular sciatica, substantially impairing daily function and work productivity in adult populations. Conventional open discectomy has gradually lost clinical priority in favor of Minimally Invasive Spinal Surgery (MISS), largely owing to its associated extensive paraspinal muscle dissection, destruction of the posterior ligamentous complex, prolonged rehabilitation, and an elevated risk of postoperative lumbar stiffness. Percutaneous Endoscopic Lumbar Discectomy (PELD), Unilateral Biportal Endoscopy (UBE), Percutaneous Endoscopic Interlaminar Discectomy (PEID), and Microendoscopic Discectomy (MED) currently represent four dominant minimally invasive modalities for LDH management, each distinguished by unique surgical corridors, visualization systems, indications, and therapeutic profiles. This comparative review synthesizes the technical workflows, perioperative metrics, complication profiles, and long-term functional outcomes of these four procedures, cross-referencing recent meta-analyses and prospective comparative clinical trials to resolve existing clinical controversies. Aggregated clinical evidence confirms that all four interventions deliver sufficient neural decompression and effective pain remission, outperforming open laminotomy discectomy in minimizing hemorrhage, shortening hospital stays, and accelerating early ambulation. Specifically, PELD achieves unparalleled minimal tissue injury for routine foraminal and central single-level LDH; UBE enables comprehensive spinal canal decompression, making it ideal for LDH concurrent with spinal stenosis, by virtue of its broad operative field and flexible instrument manipulation; PEID addresses the critical limitation of transforaminal endoscopy in excising high-grade migrated and sequestered disc fragments; and MED merges microscopic magnification with tubular retraction to balance surgical safety with soft-tissue preservation. This review further elaborates on the procedural pitfalls, contraindications, and postsurgical reherniation risk associated with each technique, thereby generating evidence-based guidance for personalized surgical decision-making and informing future technical refinement in endoscopic spinal surgery.