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Comparative analysis of patient-reported outcomes after percutaneous endoscopic lumbar discectomy between transforaminal and interlaminar approach: a minimum two year follow-up

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Abstract

Purpose

Percutaneous endoscopic lumbar discectomy has been increasingly used in the treatment of lumbar disc herniation. However, there is no consensus on which method would be more effective between the transforaminal and interlaminar approach.

Objective

To compare clinical outcomes, patient satisfaction rate, reoperation rate, and residual symptoms between percutaneous endoscopic transforaminal discectomy (PETD) and percutaneous endoscopic interlaminar discectomy (PEID).

Study design

A comparative, retrospective, controlled trial.

Setting

The study was conducted at the Department of Orthopaedics at a local hospital.

Methods

From January 2015 to September 2020, consecutive patients who underwent PETD or PEID treatment for lumbar disk herniation (LDH) at the L5/S1 level in our department were retrospectively collected. Baseline data including age, gender, body mass index (BMI), smoking status, alcohol drinking, clinical symptoms, physical examination, and radiographic characteristics were documented. During the two to three year follow-up periods, patients were evaluated clinically, including clinical outcomes assessed by the visual analog score (VAS), patient satisfaction rates assessed by the North American Spine Society patient satisfaction index (PSI), recurrent rate, and residual symptoms.

Results

A total of 113 patients with PELD in our department were included in the current study, with 65 patients in the PETD group and 48 in the PEID group. Demographic characteristics including age, gender, height, BMI, cigarette smoking, alcohol consumption status, and diabetes did not show any significant difference between the PETD and PEID groups. The VAS scores of the two groups were similar preoperatively, but the postoperative VAS score of the PEID group was lower than that of the PETD group. There were 90.8% of patients in the PETD group who were satisfied with the operation compared to 97.9% in the PEID group. The recurrence rate did not differ between groups, with three patients in both groups. Regarding residual symptoms, there were more patients in the PETD group who reported low back pain during the follow-up periods.

Limitation

The main limitations are that all patients were operated by the same surgical team from the same site, and there was a lack of multicenter data.

Conclusion

Both PETD and PEID have satisfactory patient-reported outcomes for treating LDH. The PEID procedure results in fewer low back pain residual symptoms than the PELD procedure.

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Data Availability

The data that support the findings of this study are available on request from the corresponding author upon reasonable request.

Code availability

Not applicable.

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Acknowledgements

The authors would like to thank the investigators and patients who contributed to this study.

Funding

This study was funded by Jinan Clinical Medical Science and Technology Innovation Plan (No. 202134006). This study was funded by Shandong Provincial Medical and Health Development Plan (No. 202204071067).

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Authors and Affiliations

  1. Department of Orthopedics, The 960th Hospital of the PLA, Jinan, 250031, China

    Xiaoduo Xu, Lei Wang, Jingming Wang, Kai Zhai & Weimin Huang

Authors
  1. Xiaoduo Xu
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  2. Lei Wang
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  3. Jingming Wang
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  4. Kai Zhai
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  5. Weimin Huang
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Contributions

All authors contributed to the manuscript. Study conception and design: WH; acquisition and analysis of data: XX, KZ, JW, WH; methodology: XX, JW, WH; funding acquisition: WH; writing—original draft: XX, LW; writing—review and editing: LW, WH.

Corresponding author

Correspondence to Weimin Huang.

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Informed consent was obtained from all individual participants included in the study.

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Written informed consent for publication was obtained from all participants.

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The authors declare no competing interests.

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Xu, X., Wang, L., Wang, J. et al. Comparative analysis of patient-reported outcomes after percutaneous endoscopic lumbar discectomy between transforaminal and interlaminar approach: a minimum two year follow-up. International Orthopaedics (SICOT) 47, 2835–2841 (2023). https://doi.org/10.1007/s00264-023-05935-2

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  • DOI: https://doi.org/10.1007/s00264-023-05935-2

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