Percutaneous Transforaminal Endoscopic Discectomy Versus Microendoscopic Discectomy for Lumbar Disc Herniation: 5-year Long-term Results of a Randomized Controlled Trial

Abstract

Study Design. A prospective randomized controlled study. Objective. To compare the efficacy and safety between percutaneous transforaminal endoscopic discectomy (PTED) and microendoscopic discectomy (MED). Summary of Background Data. Two kinds of minimally invasive discectomy, PTED and MED, are now widely used for treating lumbar disk herniation (LDH). The long-term comparative results of these two techniques still remained uncertain. Materials and Methods. 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 LDH and were randomly allocated to PTED or MED groups. The primary outcome was the score of Oswestry Disability Index (ODI) and the secondary outcomes included the score of Medical Outcomes Study 36-Item Short-Form Health Survey bodily pain (SF36-BP) and physical function (SF36-PF), European Quality of Life—Five Dimensions (EQ-5D), Visual Analog Scales for back pain (VAS-back) and leg pain (VAS-leg). Results. A total of 241 patients were accepted to enroll in our randomized controlled trial, of which 119 were randomly assigned to the PTED group, and the rest 122 were assigned to the MED group. A total of 194 out of 241 patients (80.5%) completed the five-year follow-up. PTED group was associated with shorter postoperative in-bed time and length of hospital stay. Both primary and secondary outcomes did not differ significantly between the two treatment groups at each follow-up time point. During the five-year follow-up, seven recurrent cases occurred in PTED and MED groups, respectively. Conclusion. Over the five-year follow-up period, PTED and MED were both efficacious in the treatment of LDH. The long-term clinical outcomes and recurrent rates were comparable between the treatment groups. PTED represents a more minimally invasive technique with the advantages of rapid recovery.

Full-Endoscopic Lumbar Discectomy Approach Selection

“…Forty-five studies were retrospective, and this was the most prevalent study design. Fourteen studies [3][4][5][10][11][12][13][14][15][16][17][18][19][20] were RCTs.…”

Minimally Invasive Discectomy and Decompression for Lumbar Spine using Tubular Retractor System: Technique, Learning Curve and Outcomes

“…Although PELD causes less damage to paraspinal muscles and posterior spinal elements as compared with MITDS, it has its own set of challenges when it comes dealing with severe calcified disc, migrated disc, large osteophyte, and foraminal stenosis. 30 31 32 33 However, MITDS is a good modality to offer in cases of LDD associated with foraminal stenosis, partially calcified disc, and in cases of obesity. With regard to PELD, MITDS has advantage of three-dimensional view and surgeon familiarity due to the use of operating microscope.…”

Spine

“…Authors of this study from Guangzhou (China) performed a randomized controlled trial (RCT) to achieve just this by focusing on the five-year clinical and patient-reported outcome measures (PROMs), and the five-year recurrence rate following presentation with a lumbar disc herniation. 1 In this single-centre, open-label RCT, patients were included if they had persistent signs and symptoms of radiculopathy with corresponding imaging-confirmed LDH, and were randomly allocated to the PTED or MED groups. The primary outcome measure selected was the Oswestry Disability Index (ODI) and the secondary outcomes included the Medical Outcomes Study 36-Item Short-Form Health Survey bodily pain (SF-36-BP) and physical function (SF-36-PF), EuroQol five-dimension (EQ-5D) questionnaire, and visual analogue scales for back pain (VAS-back) and leg pain (VAS-leg).…”