Percutaneous endoscopic lumbar discectomy and minimally invasive transforaminal lumbar interbody fusion for massive lumbar disc herniation

Abstract

ObjectivesTo compare the clinical outcomes of patients with massive lumbar disc disease undergoing percutaneous endoscopic lumbar discectomy and minimally invasive transforaminal lumbar interbody fusion at a single clinic. Patients and methodsFrom January 2008 to January 2014, 360 consecutive patients with massive lumbar disc herniation were treated with PELD(184 patients) or MIS-TLIF(176 patients). Data collected prospectively for analysis included clinical and radiographic results after revision surgery and complications. ResultsDuring the follow-up period, postoperative data between two treatment groups showed no significant difference in the mean total postoperative VAS score for leg pain, JOA and ODI scores. The recovery rate was 89.3% in the PELD and 93.4% in MIS-TLIF groups, respectively. Satisfaction rates were 86.3% in the PELD group and 92.2% in the MIS-TLIF group. Four cases of dural tear were observed in the MIS-TLIF group. Recurrence manifested in 14 patients in the PELD group, and one patient in this group also suffered permanent neurologic deficit. One case of postoperative intervertebral infection was recorded in the MIS-TLIF group. ConclusionA comparison of PELD and MIS-TLIF for treating massive lumbar disc herniation revealed that both showed favorable clinical outcomes but had different sets of complications. Compared to MIS-TLIF, PELD had the following advantages: (1) its feasibility under local anesthesia and (2) the rarity of “fusion disease,” such as ASD. However, the PELD is also revealed several problems, including a relatively lower success rate and satisfaction,a relative higher rate of postoperative long-term chronic low back pain and the possibility of recurrence, despite low opportunity. Therefore, the main difference between these two treatments was related to postoperative complications and the satisfaction and recovery rates. We suggest that, in the future, multi-center studies, recruiting a larger number of patients, should be undertaken to better understand the clinical relevance of these complications.