Percutaneous transforaminal endoscopic discectomy compared with microendoscopic discectomy for lumbar disc herniation: 1-year results of an ongoing randomized controlled trial

Abstract

<jats:sec><jats:title>OBJECTIVE</jats:title><jats:p>A prospective randomized controlled study was conducted to clarify whether percutaneous transforaminal endoscopic discectomy (PTED) results in better clinical outcomes and less surgical trauma than microendoscopic discectomy (MED).</jats:p></jats:sec><jats:sec><jats:title>METHODS</jats:title><jats:p>In this single-center, open-label, randomized controlled trial, patients were included if they had persistent signs and symptoms of radiculopathy with corresponding imaging-confirmed lumbar disc herniation. Patients were randomly allocated to the PTED or the MED group by computer-generated randomization codes. The primary outcome was the Oswestry Disability Index (ODI) score 1 year after surgery. Secondary outcomes included scores of the Medical Outcomes Study 36-Item Short-Form Health Survey bodily pain and physical function scales, EuroQol Group’s EQ-5D , and the visual analog scales for back pain and leg pain. Data including duration of operation, in-bed time, length of hospital stay, surgical cost and total hospital cost, complications, and reoperations were recorded.</jats:p></jats:sec><jats:sec><jats:title>RESULTS</jats:title><jats:p>A total of 153 participants were randomly assigned to 2 treatment groups (PTED vs MED), and 89.5% (137 patients) completed 1 year of follow-up. Primary and secondary outcomes did not differ significantly between the treatment groups at each prespecified follow-up point (p &gt; 0.05). For PTED, there was less postoperative improvement in ODI score in the median herniation subgroup at 1 week (p = 0.027), 3 months (p = 0.013), 6 months (p = 0.027), and 1 year (p = 0.028) compared with the paramedian subgroup. For MED, there was significantly less improvement in ODI score at 3 months (p = 0.008), 6 months (p = 0.028), and 1 year (p = 0.028) in the far-lateral herniation subgroup compared with the paramedian subgroup. The total complication rate over the course of 1 year was 13.75% in the PTED group and 16.44% in the MED group (p = 0.642). Five patients (6.25%) in the PTED group and 3 patients (4.11%) in the MED group suffered from residue/recurrence of herniation, for which reoperation was required.</jats:p></jats:sec><jats:sec><jats:title>CONCLUSIONS</jats:title><jats:p>Over the 1-year follow-up period, PTED did not show superior clinical outcomes and did not seem to be a safer procedure for patients with lumbar disc herniation compared with MED. PTED had inferior results for median disc herniation, whereas MED did not seem to be the best treatment option for far-lateral disc herniation.</jats:p><jats:p>Clinical trial registration no.: NCT01997086 (clinicaltrials.gov).</jats:p></jats:sec>

Efficacy of percutaneous transforaminal endoscopic decompression treatment for degenerative lumbar spondylolisthesis with spinal stenosis in elderly patients

“…The majority of dural tears are small and do not require repair during surgery. Revision decompression was required in 5.6% of patients of the present study, which is similar to the rates in other open surgery studies (5,28).…”

Epidural Catheter-Assisted Percutaneous Transforaminal Endoscopic Diskectomy: A Technical Note

“…2,4,6 PETLD offers several advantages over an open surgical approach including preservation of posterior spinal structures, less postoperative instability, less epidural scar formation, and relatively high patient satisfaction. 1,2,8 In the past, some lesions thought to be impossible to treat with PETLD are now being considered treatable. With improvements in endoscopic spinal surgery, the range of indications for PETLD has expanded.…”

“…With recent advances in instruments and techniques, minimally invasive percutaneous transforaminal endoscopic lumbar diskectomy (PETLD) for lumbar disk herniation (LDH) has evolved rapidly and gained popularity. [1][2][3][4] Despite technical advances, however, PETLD still has limitations including procedure-related pain and difficulties with migrated disk removal, direct confirmation of neural decompression, adhesiolysis around nerve roots, and determination of the procedural end point (such as when the procedure will be finished and how much it will accomplish). [4][5][6] To overcome these limitations, we performed PETLD with the help of an epidural catheter.…”

Comparison of Conventional Fenestration Discectomy with Transforaminal Endoscopic Lumbar Discectomy for Treating Lumbar Disc Herniation：Minimum 2-year Long-term Follow-up in 1,100 patients

“…Combined with radiofrequency bipolar haemostasis and reconstruction of the fenestrated brous ring, this surgical approach greatly reduces the amount of postoperative scarring around the nerve root. It also reduces the severity of denervation in the ablation of the intervertebral disc and alleviates the postoperative symptoms of lower back pain [19,20]. Radiating pain in the lower limbs is caused by mechanical compression and chemical stimulation at the nerve root.…”