Abstract
<title>Abstract</title> <p>Background Unilateral biportal endoscopy (UBE) and percutaneous endoscopic lumbar discectomy (PELD) are two mainstream minimally invasive surgical techniques for lumbar disc herniation (LDH). Most comparative studies focus only on general clinical efficacy, while analyses of postoperative complications, recurrence-related risk factors, and predictive models are insufficient for surgical decision-making. This study aimed to compare perioperative and long-term outcomes between UBE and PELD, identify independent risk factors for postoperative adverse events, and construct a predictive nomogram model to support individualized surgical selection. Methods A retrospective cohort study was performed on patients with single-level LDH who underwent UBE or PELD between January 2020 and December 2024. Perioperative parameters, Visual Analogue Scale (VAS), Oswestry Disability Index (ODI), recurrence, and complications were recorded. Univariate and multivariate logistic regression were used to screen independent risk factors. A nomogram prediction model was built and validated by C-index and calibration curves. Results A total of 216 patients were included (UBE = 107, PELD = 109). The UBE group had a longer operative time, whereas the PELD group showed less intraoperative blood loss, shorter hospital stay, and lower early back pain VAS (all P < 0.05). The overall complication rate was comparable between groups (10.2%, P > 0.05), but recurrence was significantly lower in the UBE group (P < 0.05). Multivariate regression identified age ≥ 65 years, BMI ≥ 28 kg/m², Modic Ⅱ changes, non-contained herniation, and PELD procedure as independent risk factors for adverse events. The nomogram exhibited good discrimination (C-index = 0.826) and calibration. Conclusions Both UBE and PELD are safe and effective minimally invasive surgical options for single-level LDH. PELD provides faster early postoperative recovery, while UBE yields a lower recurrence rate. The established nomogram can effectively predict postoperative adverse events and facilitate individualized surgical strategy in clinical practice.</p>