Comparison of minimally invasive percutaneous transforaminal endoscopic discectomy and microsurgical lumbar discectomy for lumbar disc herniation

Abstract

Objective To compare the clinical results between minimally invasive percutaneous transforaminal endoscopic discectomy(PELD) and microsurgical lumbar discectomy(MSLD) for lumbar disc herniation(LDH). Methods From June 2013 to December 2014, 256 patients with LDH in the Affiliated Provincial Hospital of Anhui Medical University underwent discectomy were enrolled in the research. One hundred and thirty-two patients were treated with MSLD and 124 cases with the PELD. The following measuring instruments were used: Visual analog scale for pain, the Oswestry Disability Index for patients' function and modified MacNab method for clinical outcome. The perioperative index, relief of the low back and leg pain, and clinical evaluation of each group were documented and compared respectively. Results All patients had been followed up for 5 to 35 months, averaged (20.3±4.8) months and (19.5±5.0) months in the MSLD group and PELD group, respectively. Overall, the PELD group had shorter surgical incision, shorter hospital stay and faster return to work than the MSLD group; however, operating time and radiation exposure were more than MSLD (all P values 0.05). There was no significant difference in the main clinical outcome criteria ODI between the PELD and the MSLD group. According to the modified MacNab criteria, the excellent and good rates were 94.7%(125/132)and 94.3%(117/124) in the MSLD and PELD groups in the latest follow-up, respectively, and the differences between the 2 groups were not statistically significant (χ2=0.015, P>0.05). There was no incidence of greater artery injury in each group. In MSLD group, there were 2 patients with nerve root traction injury, 1 patient with dural tear. In PELD group, there were 5 patients with postoperative dysesthesia of exiting root, 1 patient with neck pain during operation, and remnant disc fragment was found in one patient with highly migrated disc herniation. There were 2 patients of recurrence with disc herniations in each group, and were all treated with minimally invasive transforaminal lumber iterbody fusion. Conclusions Both PELD and MSLD are effective treatments for patients with LDH, and can get satisfactory clinical results. PELD have some advantages of less trauma, less pain, less duration of hospital stay, local anesthesia and early function recovery. However, it needs more radiation exposure and operation time, and it is difficult in some special patients (such as large, calcified and highly migrated disc herniations), PELD may be helpful for these patients. Key words: Intervertebral disc displacement; lumbar disc herniation; Surgical procedures, minimally invasive; Endoscopes