Transforaminal Endoscopic Discectomy versus Microdiscectomy for Treatment of Lumbar Disc Herniation and Associated Unilateral Sciatica: A Comparative Study

Abstract

Abstract Background Data: Recently, transforaminal endoscopic discectomy (TED) has become accepted as a safe alternative procedure for microdiscectomy (MID) in lumbar disc surgery. Numerous studies compared microdiscectomy with interlaminar endoscopic discectomy; however, the number of studies comparing MID with TED is relatively limited. Purpose: To compare TED and MID in treating lower lumbar disc prolapse (LDP) and associated unilateral sciatica in terms of overall outcome, complications, and rate of recurrence. Study Design: Retrospective clinical case series. Patients and Methods: This retrospective study included one hundred patients with low back pain and unilateral sciatica due to lower lumbar herniated discs. They were divided into 2 groups, each one consisted of 50 patients: Group A underwent MID and Group B TED. Clinical assessments of all patients were conducted using Visual Analogue Score (VAS) and Oswestry Disability Index (ODI) preoperatively and at one-year postoperative follow-up. Results: In this study, one hundred patients were surgically treated (50 for MID and 50 for TED) from June 2017 to December 2018. The mean age was 40.44 ± 11.31 and 41.14 ± 11.60 years for MID and TED, respectively. Males were most affected in both TED and MID groups (76% in MID and 66% in TED). The most affected disc level in both groups was the L4-L5 level, representing 60% and 68% for MID and TED, respectively. The mean operative time was 63.82 ± 17.37 and 72.60 ± 16.90 minutes for MID and TED, respectively, with significant difference (p = 0.02). Upon comparing the postoperative values, all patients in both groups showed a significant improvement in their preoperative back pain, leg pain, and ODI scores. According to Macnab’s Outcome Criteria, in our study, the results were as follows: for the MED group, overall good to excellent outcomes in 92% (N = 46), fair in 4% (N = 2), and poor in 4% (N = 2); for the TED group, overall good to excellent outcomes in 86% (N = 43), fair in 6% (N = 3), and poor in 8% (N = 4). Conclusion: Percutaneous posterolateral transforaminal discectomy has become a relatively safe and effective procedure over the last years; however, MID is the gold standard surgical approach till now for treating LDP and associated sciatica. (2020ESJ211) Abstract Background Data: Recently transforaminal endoscopic discectomy become accepted as a safe alternative procedure for microdiscectomy in lumbar disc surgey. There are a lot of studies comparing the microdiscectomy with the interlaminar endoscopic discectomy ,but the number of studies which comparing the microdiscectomy with the transforaminal endoscopic one are relatively limited Purpose: In this study, we aim to compare between transforaminal endoscopic discectomy and microdiscectomy in treatment of lower lumbar disc prolapse and associated unilateral sciatica in terms of overall outcome, complications, and rate of recurrence. Study design: Retrospective clinical case series. Patients and methods A retrospective study involved one hundred (100) patients with low back pain and unilateral sciatica due to lower lumbar herniated discs divided into 2 groups each one consisted of 50 patients ,group (A) treated with microdiscectomy (MID),group(B) operated by transforaminal endoscopic discectomy(TED). Preoperative clinical assessment of all patients has done using visual analogue score (VAS) and Oswestry Disability Index (ODI) and follow up was done at 1 month,6month, and 12, months postoperatively. Results: In the current study, one hundred (100) patients were surgically treated (50 for MID and 50 for TED) from June 2017 to December 2018, the mean age (40.44± 11.31 &41.14 ±11.60 years for MID and TED respectively, males were most affected in both TED and MID groups (76% in MID and 66% in TED). The most affected disc level in both groups was L4-5 level(60%&68% for MID and TED respectively).Mean operative time was(63.82 ±17.37&72.60 ±16.90 minutes for MID and TED respectively with Significant difference P<0.05). The mean hospital stay was (29.80± 31.73&14.76± 11.20 hours for MID and TED respectively with significant relation P=0.02). Compared to the post-operative values, all patients in both groups showed a significant improvement of their preoperative back pain, leg pain and ODI scores. According to Mac Nab’s Outcome Criteria, in our study, overall good to excellent results for MED group (46pts, 92%), fair (2pts 4%) and poor outcome in (2 pts 4%).and overall good to excellent of TED group was (43 pts, 86%), fair (3pts, 6%), poor outcome (4pts, 8%). Conclusion: Percutaneous posterolateral transforaminal discectomy has become a relative safe, effective procedure over the last years, but microdiscectomy is the gold standard surgical approach till now for treatment of lumbar disc prolapse and associated sciatica. Key words: Transforaminal, microdiecectomy, endoscopic, sciatica, kambin, dysesthesia