Percutaneous endoscopic lumbar discectomy versus open lumbar microdiscectomy for treating lumbar disc herniation: Using the survival analysis

Abstract

A BSTRACT Objectives: This study compared the risk of symptomatic recurrent disc herniation and clinical outcomes of percutaneous endoscopic lumbar discectomy (PELD) versus open lumbar microdiscectomy (OLM) for lumbar disc herniation with 2 years of follow-up. Materials and Methods: We analyzed 23 patients who underwent PELD and 32 patients who underwent OLM for lumbar disc herniation. The numeric rating scale of back and leg pain, Oswestry Disability Index (ODI), and Roland–Morris Disability Questionnaire (RMDQ) were assessed before and at 12 and 24 months after the surgery. The wound pain and complications were also recorded. Survival analysis was performed to estimate the risk of symptomatic recurrent disc herniation. Results: In the comparison of groups, the reductions in back and leg pain, ODI, and RMDQ were not significantly different at 12 and 24 months. For patients who underwent PELD, the wound pain was significant lower at the day of surgery. The survival rate of patients who were free from symptomatic recurrent disc herniation at 24 months was 0.913 in PELD and 0.875 in OLM, and the log-rank test revealed no significant difference between the two survival curves. The incidence of complication was not significantly different between groups. Conclusion: Both PELD and OLM are effective treatments for lumbar disc herniation because they have similar clinical outcomes. PELD provided patients with less painful wounds. The survival analysis revealed that the risk of symptomatic recurrent disc herniation in 2 years of follow-up was not different between PELD and OLM.

Surgical Strategy for Lumbar Disc Herniation based on the MSU Classification: Percutaneous Endoscopic Lumbar Discectomy versus Transforaminal Lumbar Interbody Fusion: A 5‐year Retrospective Study

“…In contrast, the traditional TLIF technique, introduced in 1982, effectively treats LDH by removing the damaged disc and using a cage and bone grafting for fusion, thus restoring spinal stability and relieving symptoms 19,20 . Traditional TLIF is believed to offer higher fusion success rates, lower recurrence rates, better removal of the nucleus pulposus, and improved vertebral stability 21–23 . However, TLIF surgery has drawbacks, including increased intraoperative injury, an extended recovery period, and a higher risk of potential complications such as infection, hematoma, screw loosening or breakage, and cage subsidence 24 .…”

“… 19 , 20 Traditional TLIF is believed to offer higher fusion success rates, lower recurrence rates, better removal of the nucleus pulposus, and improved vertebral stability. 21 , 22 , 23 However, TLIF surgery has drawbacks, including increased intraoperative injury, an extended recovery period, and a higher risk of potential complications such as infection, hematoma, screw loosening or breakage, and cage subsidence. 24 Notably, no comparison of the clinical efficacy of PELD and traditional TLIF surgical strategies based on LDH classification has been reported.…”