Comparison of Percutaneous Endoscopic Interlaminar Discectomy and Open Fenestration Discectomy for Single-Segment Huge Lumbar Disc Herniation: A Two-year Follow-up Retrospective Study

Abstract

Purpose Both percutaneous endoscopic lumbar discectomy (PELD) and open fenestration discectomy (OFD) are effective and safe surgical procedures for the treatment of LDH. The purpose of this retrospective study was to compare the surgical outcomes of percutaneous endoscopic interlaminar discectomy (PEID) and OFD for single-segment huge lumbar disc herniation (HLDH). Patients and Methods We retrospectively analyzed 91 patients diagnosed with single-segment HLDH and treated with OFD or PEID. Visual analog scale (VAS), modified Japanese orthopedic association (mJOA) and Oswestry disability index (ODI) were used to assess clinical outcomes at preoperation and postoperatively at 3, 6, 12, and 24months. Modified Macnab criteria were applied to evaluate clinically satisfaction at the final follow-up. Results In both groups, the VAS and ODI scores at 3, 6, 12, and 24months postoperatively showed a significant decrease and the mJOA score at 3, 6, 12, and 24months postoperatively was significantly increased compared to preoperative results ( P <0.001). According to Macnab criteria at the final follow-up, the overall clinically satisfactory rate was 86.67% in the OFD group and 86.96% in the PEID group. There were no significant differences in VAS, ODI, and mJOA scores between the two groups at preoperation and postoperative 3, 6, 12, and 24months, respectively. In the PEID group, the length of hospitalization and the length of incision were significantly shorter than that in the OFD group ( P <0.0001). However, there was no significant difference in operative time between groups ( P =0.81). Conclusion Collectively, postoperative clinical results were equally favorable for both procedures, with no statistically significant difference between PEID and OFD at the two-year of follow-up. No serious complication was observed in two groups. Compared with the traditional surgery, PEID has the following benefits: less trauma, less bleeding, speedy recovery, and shorter hospitalization. Therefore, PEID may be a promising alternative to traditional surgery.

Comparison of percutaneous endoscopic interlaminar discectomy and conventional open lumbar discectomy for L4/5 and L5/S1 double-segmental lumbar disk herniation

“…COLD is still the standard procedure for the treatment of LDH, with few complications and satisfactory outcomes. It has significant advantages in the treatment of complex LDH, such as larger LDH, extreme lateral LDH, and LDH accompanied by spinal stenosis [ 5 , 6 , 12 ]. However, with the development of microscopic techniques and the improvement of surgical skills, because of its advantages of less bleeding and soft tissue damage, maintenance of spinal stability, shorter hospital stays, and enhanced recovery after surgery, PELD is slowly replacing COLD as the gold standard for LDH [ 13 ].…”

Technical feasibility of combined uniportal unilateral laminotomy with bilateral decompression and interlaminar lumbar discectomy surgery for cauda equina syndrome due to lower lumbar disc herniation

“…There are still challenges to overcome with endoscopic decompression such as iatrogenic instability due to the inevitable violation of the medial facet joint [ 47 ]. Thus, uniportal interlaminar endoscopic decompression and discectomy is an effective alternative to open laminectomy for patients with cauda equina syndrome and has the following benefits: less trauma, less post-operative pain, shorter hospitalization, and lower postoperative infection rates [ 48 ].…”

Analysis of the therapeutic effect and postoperative complications associated with 3-dimensional computed tomography navigation-assisted intervertebral foraminoscopic surgery in lumbar disc herniation in the elderly: a retrospective cohort study

“…For patients whose symptoms are not relieved after 6 weeks of conservative treatment, surgery is recommended to avoid irreversible changes in the nerve root structure due to chronic compression. Approximately 10–20% of patients in whom conservative treatment has failed require surgical treatment ( 6 ). The traditional open surgical method can achieve certain therapeutic effects, but it often leads to a lack of structural integrity in the lumbar spinal canal of patients.…”