Microendoscopic Discectomy Combined with Annular Suture Versus Percutaneous Transforaminal Endoscopic Discectomy for Lumbar Disc Herniation: A Prospective Observational Study

Abstract

Background Microendoscopic discectomy (MED) and percutaneous transforaminal endoscopic discectomy (PTED) are 2 of the most popular minimally invasive spinal surgery techniques. We are investigating whether minimally invasive early annular closure can achieve a better clinical effect in the treatment of lumbar disc herniation (LDH). Objective To compare the clinical and imaging outcomes between MED combined with annular suture and PTED in the treatment of LDH. Study design A prospective observational study with follow-up of 36 months. Setting The First People's Hospital of Lianyungang in China. Methods A total of 135 prospective consecutive patients underwent MED + annular suture or PTED. Patients were assessed postoperatively at 3 days and 3, 6, 12, 24, and 36 months. The outcome measures were visual analog scales for back pain (VAS-back) and leg pain (VAS-leg) scores, the Oswestry Disability Index (ODI) score, the Medical Outcomes Study 36-Item Short-Form Health Survey bodily pain (SF36-BP), and physical function (SF36-PF) scales, disc height, and recurrence rate. Results One hundred and six patients have completed the 3-year follow-up. The operation time and length of stay in the MED + annular suture group were longer than that in the PTED group (P Limitations First, this was not a randomized controlled trail, which could provide more evidence-based conclusions. Second, we did not accurately measure and compare the amount of nucleus pulposus removed, although less nucleus pulposus was removed in MED + annular suture. Conclusion PTED has the advantages of shorter length of incision, shorter operation time, and shorter length of stay. MED + annular suture is associated with greater preservation of disc height, and showed certain advantages of lower recurrence rate, although there was no statistical difference.