CardioVascular and Interventional Radiology

, Volume 33, Issue 4, pp 780–786 | Cite as

Long-Term Outcomes of Patients with Lumbar Disc Herniation Treated with Percutaneous Discectomy: Comparative Study with Microendoscopic Discectomy

  • Wen-Gui Liu
  • Xiao-Tao Wu
  • Jin-He Guo
  • Su-Yang Zhuang
  • Gao-Jun TengEmail author
Clinical Investigation


We assessed the long-term outcomes of patients with lumbar disc herniation treated with percutaneous lumbar discectomy (PLD) or microendoscopic discectomy (MED). A retrospective study was performed in consecutive patients with lumbar disc herniation treated with PLD (n = 129) or MED (n = 101) in a single hospital from January 2000 to March 2002. All patients were followed up with MacNab criteria and self-evaluation questionnaires comprising the Oswestry Disability Index and Medical Outcomes Study 36-Item Short-Form Health Survey. Several statistical methods were used for analyses of the data, and a p value of <0.05 was considered to be statistically significant. A total of 104 patients (80.62%) with PLD and 82 patients (81.19%) with MED were eligible for analyses, with a mean follow-up period of 6.64 ± 0.67 years and 6.42 ± 0.51 years, respectively. There were no significant differences between the two groups in age, number of lesions, major symptoms and physical signs, and radiological findings. According to the MacNab criteria, 75.96% in the PLD group and 84.15% in the MED group achieved excellent or good results, respectively, this was statistically significant (p = 0.0402). With the Oswestry Disability Index questionnaires, the average scores and minimal disability, respectively, were 6.97 and 71.15% in the PLD group and 4.89 and 79.27% in the MED group. Total average scores of Medical Outcomes Study 36-Item Short-Form Health Survey were 75.88 vs. 81.86 in PLD group vs. MED group (p = 0.0582). The cost and length of hospitalization were higher or longer in MED group, a statistically significant difference (both p < 0.0001). Long-term complications were observed in two patients (2.44%) in the MED group, no such complications were observed in the PLD group. Both PLD and MED show an acceptable long-term efficacy for treatment of lumbar disc herniation. Compared with MED patients, long-term satisfaction is slightly lower in the PLD patients; complications, hospitalization duration, and costs in PLD group are also lower.


Lumbar disc Herniation Discectomy Percutaneous Microendoscopic Follow-up Long-term outcomes Quality of life 



We thank Jie Min for her contributions to the statistical analyses, and Li Li and Rui Dong for their assistance in English-language editing.


  1. 1.
    Lee SH, Chung SE, Yong A et al (2006) Comparative radiologic evaluation of percutaneous endoscopic lumbar discectomy and open microdiscectomy: a matched cohort analysis. Mt Sinai J Med 73:795–801PubMedGoogle Scholar
  2. 2.
    Tassi GP (2006) Comparison of results of 500 microdiscectomies and 500 percutaneous laser disc decompression procedures for lumbar disc herniation. Photomed Laser Surg 24:694–697CrossRefPubMedGoogle Scholar
  3. 3.
    Schizas C, Tsiridis E, Saksena J (2005) Microendoscopic discectomy compared with standard microsurgical discectomy for treatment of uncontained or large contained disc herniations. Neurosurgery 57:357–360CrossRefPubMedGoogle Scholar
  4. 4.
    Revel M, Payan C, Vallee C et al (1993) Automated percutaneous lumbar discectomy versus chemonucleolysis in the treatment of sciatica. A randomized multicenter trial. Spine 18:1–7CrossRefPubMedGoogle Scholar
  5. 5.
    Krugluger J, Knahr K (2000) Chemonucleolysis and automated percutaneous discectomy—a prospective randomized comparison. Int Orthop 24:167–169CrossRefPubMedGoogle Scholar
  6. 6.
    Chatterjee S, Foy PM, Findlay GF (1995) Report of a controlled clinical trial comparing automated percutaneous lumbar discectomy and microdiscectomy in the treatment of contained lumbar disc herniation. Spine 20:734–738CrossRefPubMedGoogle Scholar
  7. 7.
    Haines SJ, Jordan N, Boen JR et al (2002) LAPDOG/LEAPDOG Investigators. Discectomy strategies for lumbar disc herniation: results of the LAPDOG trial. J Clin Neurosci 9:411–417CrossRefPubMedGoogle Scholar
  8. 8.
    Bonaldi G (2003) Automated percutaneous lumbar discectomy: technique, indications and clinical follow-up in over 1000 patients. J Neuroradiol 45:735–743CrossRefGoogle Scholar
  9. 9.
    Cosma A, Mario M, Marco L (2004) Interventional spinal procedures. Eur J Radiol 50:112–119CrossRefGoogle Scholar
  10. 10.
    Onik G, Clyde A, Helms CA (1991) Automated percutaneous lumbar diskectomy. AJR Am J Roentgenol 156:531–538PubMedGoogle Scholar
  11. 11.
    Degobbis A, Crucil M, Alberti M, Bortolussi A (2005) A long-term review of 50 patients out of 506 treated with automated percutaneous nucleotomy according to Onik for lumbar-sacral disc herniation. Acta Neurochir 92:103–105CrossRefGoogle Scholar
  12. 12.
    Foley KT, Smith MM (1997) Microendoscopic discectomy. Techn Neurosurg 3:301–307Google Scholar
  13. 13.
    Alok R, Rahul L (2006) Microendoscopic discectomy for prolapsed lumbar intervertebral disc. Neurol India 54:190–194Google Scholar
  14. 14.
    Foley KT, Smith MM, Rampersaud YR (1999) Microendoscopic approach to far lateral lumbar disc herniation. Neurosurg Focus 7:5CrossRefGoogle Scholar
  15. 15.
    Chang SS, Fu TS, Liang YC et al (2009) Results of microendoscopic discectomy performed in the 26 cases with a minimum 3 years follow-up. Chang Gung Med J 32:89–97PubMedGoogle Scholar
  16. 16.
    Rong LM, Xie PG, Shi DH et al (2008) Spinal surgeons’ learning curve for lumbar microendoscopic discectomy: a prospective study of our first 50 and latest 10 cases. Chin Med J 121:2148–2151PubMedGoogle Scholar
  17. 17.
    Teng GJ, Jeffery RF, Guo JH et al (1997) Automated percutaneous lumbar discectomy: a prospective multi-institutional study. J Vasc Interv Radiol 8:457–463CrossRefPubMedGoogle Scholar
  18. 18.
    Wu XT, Zhuang SY, Mao Z et al (2006) Microendoscopic discectomy for lumbar disc herniation: surgical technique and outcome in 873 consecutive cases. Spine 31:2689–2694CrossRefPubMedGoogle Scholar
  19. 19.
    Luo X, Pietrobon R, Sun SX et al (2004) Estimates and patterns of direct health care expenditures among individuals with back pain in the United States. Spine 29:79–86CrossRefPubMedGoogle Scholar
  20. 20.
    Long MD (1991) Decision making in lumbar disc disease. Clin Neurosurg 39:36–51Google Scholar
  21. 21.
    Olmarker K, Rydebik B (1991) Pathophysiology of sciatica. Orthop Clin North Am 22:223–234PubMedGoogle Scholar
  22. 22.
    Mark V, Andrea M, Sukdeb D et al (2007) Interventional techniques: evidence-based practice guidelines in the management of chronic spinal pain. Pain Physician 10:7–111Google Scholar
  23. 23.
    Hirsch JA, Singh V, Falco FJE et al (2009) Automated percutaneous lumbar discectomy for the contained herniated lumbar disc: a systematic assessment of evidence. Pain Physician 12:601–620PubMedGoogle Scholar
  24. 24.
    Brian JC (2008) Intradiscal electrothermal therapy, percutaneous discectomy, and nucleoplasty: what is the current evidence? Curr Pain Headache Rep 12:14–21CrossRefGoogle Scholar
  25. 25.
    Maurits W, Bart K, Seppo S et al (2006) Outcome of invasive treatment modalities on back pain and sciatica: an evidence-based review. Eur Spine J 15:S82–S92CrossRefGoogle Scholar
  26. 26.
    Fairbank JC, Pynsent PB (2000) The Oswestry Disability Index. Spine 25:2940–2953CrossRefPubMedGoogle Scholar
  27. 27.
    Roland M, Fairbank J (2000) The Roland-Morris Disability Questionnaire and the Oswestry Disability Questionnaire. Spine 25:3115–3124CrossRefPubMedGoogle Scholar
  28. 28.
    Hideki H, Magahi K, Osamu N et al (2006) Discriminative validity and responsiveness of the Oswestry Disability Index among Japanese outpatients with lumbar conditions. Eur Spine J 15:1645–1650CrossRefGoogle Scholar
  29. 29.
    Fairbank JC, Couper J, Davies JB, O’Brien JP (1980) The Oswestry Low Back Pain Disability Questionnaire. Physiotherapy 66:271–273PubMedGoogle Scholar
  30. 30.
    Zanoli G, Jonsson B, Stromqvist B (2006) SF-36 scores in degenerative lumbar spine disorders: analysis of prospective data from 451 patients. Acta Orthop 77:298–306CrossRefPubMedGoogle Scholar
  31. 31.
    Stansfeld SA, Roberts R, Foot SP (1997) Assessing the validity of the SF-36 General Health Survey. Qual Life Res 6:217–224CrossRefPubMedGoogle Scholar
  32. 32.
    Hollingworth W, Deyo RA, Sullivan SD et al (2002) The practicality and validity of directly elicited and SF-36 derived health state preferences in patients with low back pain. Health Econ 11:71–85CrossRefPubMedGoogle Scholar
  33. 33.
    Kotryna V, Kazys V, Ambrozaitis Bronius Š (2007) Health-related quality-of-life assessment in patients with low back pain using SF-36 questionnaire. Medicina (Kaunas) 43:607–613Google Scholar
  34. 34.
    Dirk H, Katharina K, Margrit Z et al (2007) Health-related quality of life in patients after lumbar disc surgery: a longitudinal observational study. Qual Life Res 16:1453–1460CrossRefGoogle Scholar
  35. 35.
    Walsh TL, Hanscom B, Lurie JD et al (2003) Is a condition-specific instrument for patients with low back pain/leg symptoms really necessary? The responsiveness of the Oswestry Disability Index, MODEMS, and the SF-36. Spine 28:607–615CrossRefPubMedGoogle Scholar
  36. 36.
    Grevitt M, Khazim R, Webb J et al (1997) The short form-36 health survey questionnaire in spine surgery. J Bone Joint Surg Br 79:48–52CrossRefPubMedGoogle Scholar
  37. 37.
    Macnab I (1971) Negative disc exploration: an analysis of the causes of nerve-root involvement in sixty-eight patients. J Bone Joint Surg Am 53:891–903PubMedGoogle Scholar
  38. 38.
    Bernd L, Schiltenwolf M, Mau H, Schindele S (1997) No indications for percutaneous lumbar discectomy? Int Orthop 21:164–168CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2009

Authors and Affiliations

  • Wen-Gui Liu
    • 1
    • 2
  • Xiao-Tao Wu
    • 3
  • Jin-He Guo
    • 1
  • Su-Yang Zhuang
    • 3
  • Gao-Jun Teng
    • 1
    Email author
  1. 1.Department of Radiology, Zhong-Da HospitalSoutheast UniversityNanjingChina
  2. 2.Department of Interventional RadiologyJiangsu Traditional Chinese Medical HospitalNanjingChina
  3. 3.Department of Orthopedics, Zhong-Da HospitalSoutheast UniversityNanjingChina

Personalised recommendations