Better Functional Outcome and Pain Relief in the Far-Lateral-Outside-in Percutaneous Endoscopic Transforaminal Discectomy

Abstract

Background Even though percutaneous endoscopic transforaminal discectomy (PETD) has been widely used for the surgical treatment of lumbar herniated disc, there are only a few studies directly comparing the clinical outcomes between microdiscectomy (MD) and PETD. Therefore, further studies are needed in order to compare the clinical outcomes between PETD and MD on a single level more thoroughly. Methods We proposed a far-lateral-outside-in technique for PETD to get an entry point without complex planning and facet violation. From September 2017 to September 2019, a total of 155 patients (69 with PETD and 86 with MD) were enrolled for this retrospective study, with the inclusion criteria: single level between L2 and S1, clinical sciatica for at least 6 weeks, and failed attempts with non-surgical treatments. Patients were excluded due to cauda equina syndrome, progressive neurologic deficits, history of lumbar spinal surgery, endplate modic changes, severe disc degeneration and less than 24 months of follow-up. Results PETD showed significantly shorter surgery time and less intraoperative blood loss compared to MD. The difference between PETD and MD in VAS back pain (but not VAS leg pain) at follow-up time was significant. The ODI improvement in the follow-up time of 6 months between the 2 groups showed a significant difference (PETD: 31.23±6.59, MD: 39.85±7.81, p < 0.001). MD had a significantly higher chance of postoperative wound infection and poor healing, while PETD was more likely to have recurrence of the herniated disc. Conclusion MD has been the gold standard procedure for LDH. However, with the advanced endoscopic technology and surgical technique, PETD has emerged as an alternative method due to higher functional outcome and less wound problems.

Outcomes of FETD versus UBE in the treatment of L5S1 foraminal stenosis: A comparative study

“…FETD, one of the most popular minimally invasive spinal surgeries, employs precise decompression with a narrow operative view and relies on fluoroscopic guidance. Although previous studies have demonstrated a high success rate for this technique [ [7] , [8] , [9] ], Choi et al reported that an incomplete removal of herniated discs as a complication of FETD, accounted for 64.9% of unsuccessful cases [ 20 ]. In a review article, Pan et al also reported that incomplete disc removal was one of the complications of FETD [ 17 ].…”

“…Previous studies have demonstrated that both FETD [ [7] , [8] , [9] , [10] ] and UBEFLA [ [11] , [12] , [13] ] produce similar or even superior outcomes relative to MD. With advancements in surgical techniques and outcomes, FETD and UBEFLA have been widely applied for treating lumbar FS.…”

PL-TOSP, the Novel Entry Point in Transforaminal Endoscopic Spine Surgery: Radiological Analysis with Prospective Surgical Evaluation and Review of Literature of Various Skin Entry Points

“…26 Furthermore, Wang et al reported better functional outcomes and pain relief with percutaneous endoscopic transforaminal discectomy compared with microdiscectomy, further supporting the efficacy of endoscopic approaches in spinal surgeries. 27…”