This study aimed to evaluate the clinical outcomes of full-endoscopic foraminoplasty and lumbar discectomy (FEFLD), unilateral biportal endoscopic (UBE) discectomy, and microdiscectomy (MD) in the treatment of symptomatic lumbar disc herniation (LDH).
From January 2020 and May 2021, 128 patients with single-level LDH at L4-5 or L5-S1 received FEFLD, UBE discectomy or MD. Patients were divided into three groups according to surgical method: the FEFLD group (n = 43), the UBE group (n = 42), and the MD group (n = 43). Operative time, fluoroscopy frequency, in-bed time, length of hospital stays, total expenses, complications, visual analogue scale (VAS, 0–10), and Oswestry Disability Index (ODI, 0–100%) were assessed and compared among three groups.
There were no significant differences in VAS or ODI scores at 12 months after surgery among three groups. In comparison with the MD group, the FEFLD and UBE group yield better VAS scores for back pain on the first day following surgery (P < 0.05). The FEFLD group was superior to the UBE group or MD group with less time in bed and shorter hospital stay (P < 0.05). The operation time and total expenses in the UBE group were significantly longer and higher than those in the FEFLD group or MD group (P < 0.05).
FEFLD and UBE discectomy yield comparable results to conventional MD concerning pain relief and functional outcomes. In addition, FEFLD and UBE discectomy enable less back pain in the immediate postoperative period. FEFLD offers advantages in rapid recovery. Conventional MD is still an efficient and cost-effective surgical procedure.
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Data and materials availability
Raw data would be made available on reasonable request and with the permission of the institution where the data were generated. Hengrui Chang was the person to be contacted if someone wants to request the data from this study.
Kreiner DS, Hwang SW, Easa JE, Resnick DK, Baisden JL, Bess S, Cho CH, DePalma MJ, Dougherty P 2nd, Fernand R, Ghiselli G, Hanna AS, Lamer T, Lisi AJ, Mazanec DJ, Meagher RJ, Nucci RC, Patel RD, Sembrano JN, Sharma AK, Summers JT, Taleghani CK, Tontz WL Jr, Toton JF (2014) An evidence-based clinical guideline for the diagnosis and treatment of lumbar disc herniation with radiculopathy. Spine J : Off J N Am Spine Soc 14:180–191. https://doi.org/10.1016/j.spinee.2013.08.003
Koes BW, van Tulder MW, Peul WC (2007) Diagnosis and treatment of sciatica. BMJ (Clin Res Ed) 334:1313–1317. https://doi.org/10.1136/bmj.39223.428495.BE
Gibson JN, Waddell G (2007) Surgical interventions for lumbar disc prolapse. Cochrane Database Syst Rev: Cd001350. https://doi.org/10.1002/14651858.CD001350.pub3
Ahn SS, Kim SH, Kim DW, Lee BH (2016) Comparison of outcomes of percutaneous endoscopic lumbar discectomy and open lumbar microdiscectomy for young adults: a retrospective matched cohort study. World Neurosurg 86:250–258. https://doi.org/10.1016/j.wneu.2015.09.047
Weinstein JN, Tosteson TD, Lurie JD, Tosteson AN, Hanscom B, Skinner JS, Abdu WA, Hilibrand AS, Boden SD, Deyo RA (2006) Surgical vs nonoperative treatment for lumbar disk herniation: the spine patient outcomes research trial (SPORT): a randomized trial. JAMA 296:2441–2450. https://doi.org/10.1001/jama.296.20.2441
Imhof HG, von Ammon K, Yasargil MG (1994) Use of the microscope in surgery of lumbar disk hernia. Aktuelle Probl Chir Orthop 44:15–20
Caspar W, Campbell B, Barbier DD, Kretschmmer R, Gotfried Y (1991) The Caspar microsurgical discectomy and comparison with a conventional standard lumbar disc procedure. Neurosurgery 28:78–86. https://doi.org/10.1097/00006123-199101000-00013
Awad JN, Moskovich R (2006) Lumbar disc herniations: surgical versus nonsurgical treatment. Clin Orthop Relat Res 443:183–197. https://doi.org/10.1097/01.blo.0000198724.54891.3a
Casal-Moro R, Castro-Menéndez M, Hernández-Blanco M, Bravo-Ricoy JA, Jorge-Barreiro FJ (2011) Long-term outcome after microendoscopic diskectomy for lumbar disk herniation: a prospective clinical study with a 5-year follow-up. Neurosurgery 68:1568–1575; discussion 1575. https://doi.org/10.1227/NEU.0b013e31820cd16a
Wenger M, Mariani L, Kalbarczyk A, Gröger U (2001) Long-term outcome of 104 patients after lumbar sequestrectomy according to Williams. Neurosurgery 49:329–334. https://doi.org/10.1097/00006123-200108000-00013
Franke J, Greiner-Perth R, Boehm H, Mahlfeld K, Grasshoff H, Allam Y, Awiszus F (2009) Comparison of a minimally invasive procedure versus standard microscopic discotomy: a prospective randomised controlled clinical trial. Eur Spine J : Off Publ Euro Spine Soc, Euro Spinal Deform Soc, Euro Sect Cerv Spine Res Soc 18:992–1000. https://doi.org/10.1007/s00586-009-0964-2
Arts MP, Brand R, van den Akker ME, Koes BW, Bartels RH, Peul WC (2009) Tubular diskectomy vs conventional microdiskectomy for sciatica: a randomized controlled trial. JAMA 302:149–158. https://doi.org/10.1001/jama.2009.972
Ryang YM, Oertel MF, Mayfrank L, Gilsbach JM, Rohde V (2008) Standard open microdiscectomy versus minimal access trocar microdiscectomy: results of a prospective randomized study. Neurosurgery 62:174–181. https://doi.org/10.1227/01.Neu.0000311075.56486.C5
Lee DY, Shim CS, Ahn Y, Choi YG, Kim HJ, Lee SH (2009) Comparison of percutaneous endoscopic lumbar discectomy and open lumbar microdiscectomy for recurrent disc herniation. J Korean Neurosurg Soc 46:515–521. https://doi.org/10.3340/jkns.2009.46.6.515
Ruetten S, Komp M, Merk H, Godolias G (2008) Full-endoscopic interlaminar and transforaminal lumbar discectomy versus conventional microsurgical technique: a prospective, randomized, controlled study. Spine 33:931–939. https://doi.org/10.1097/BRS.0b013e31816c8af7
Yeung AT, Tsou PM (2002) Posterolateral endoscopic excision for lumbar disc herniation: surgical technique, outcome, and complications in 307 consecutive cases. Spine 27:722–731. https://doi.org/10.1097/00007632-200204010-00009
Zhao Y, Yuan S, Tian Y, Liu X (2020) Necessity of routinely performing foraminoplasty during percutaneous endoscopic transforaminal discectomy (PETD) for lumbar disc herniation. Br J Neurosurg. https://doi.org/10.1080/02688697.2020.1817853
Ouyang ZH, Tang M, Li HW, Zou MX, Li XL, Wang WJ, Yan YG (2021) Full-endoscopic foraminoplasty using a visualized bone reamer in the treatment of lumbar disc herniation: a retrospective study of 80 cases. World Neurosurg 149:e292–e297. https://doi.org/10.1016/j.wneu.2021.02.033
Hua W, Zhang Y, Wu X, Gao Y, Li S, Wang K, Yang S, Yang C (2019) Full-endoscopic visualized foraminoplasty and discectomy under general anesthesia in the treatment of L4–L5 and L5–S1 disc herniation. Spine 44:E984-e991. https://doi.org/10.1097/brs.0000000000003014
Cai H, Liu C, Lin H, Wu Z, Chen X, Zhang H (2022) Full-endoscopic foraminoplasty for highly down-migrated lumbar disc herniation. BMC Musculoskelet Disord 23:303. https://doi.org/10.1186/s12891-022-05254-4
Kim SK, Kang SS, Hong YH, Park SW, Lee SC (2018) Clinical comparison of unilateral biportal endoscopic technique versus open microdiscectomy for single-level lumbar discectomy: a multicenter, retrospective analysis. J Orthop Surg Res 13:22. https://doi.org/10.1186/s13018-018-0725-1
Jiang HW, Chen CD, Zhan BS, Wang YL, Tang P, Jiang XS (2022) Unilateral biportal endoscopic discectomy versus percutaneous endoscopic lumbar discectomy in the treatment of lumbar disc herniation: a retrospective study. J Orthop Surg Res 17:30. https://doi.org/10.1186/s13018-022-02929-5
Lin GX, Huang P, Kotheeranurak V, Park CW, Heo DH, Park CK, Park JY, Kim JS (2019) A systematic review of unilateral biportal endoscopic spinal surgery: preliminary clinical results and complications. World Neurosurg 125:425–432. https://doi.org/10.1016/j.wneu.2019.02.038
Soliman HM (2013) Irrigation endoscopic discectomy: a novel percutaneous approach for lumbar disc prolapse. Euro Spine J : Off Publ Euro Spine Soc, Euro Spinal Deform Soc, Euro Sect Cerv Spine Res Soc 22:1037–1044. https://doi.org/10.1007/s00586-013-2701-0
Hao J, Cheng J, Xue H, Zhang F (2022) Clinical comparison of unilateral biportal endoscopic discectomy with percutaneous endoscopic lumbar discectomy for single l4/5-level lumbar disk herniation. Pain Pract: Off J World Inst Pain 22:191–199. https://doi.org/10.1111/papr.13078
Kim JE, Choi DJ (2018) Unilateral biportal endoscopic decompression by 30° endoscopy in lumbar spinal stenosis: technical note and preliminary report. J Orthop 15:366–371. https://doi.org/10.1016/j.jor.2018.01.039
Choi DJ, Choi CM, Jung JT, Lee SJ, Kim YS (2016) Learning curve associated with complications in biportal endoscopic spinal surgery: challenges and strategies. Asian Spine J 10:624–629. https://doi.org/10.4184/asj.2016.10.4.624
White CA, Patel AV, Butler LR, Amakiri UO, Yeshoua BJ, Steinberger JM, Cho SK, Kim JS (2022) Comparison of patient preference, understanding, and sentiment for minimally invasive versus open spine surgery. Spine 47:309–316. https://doi.org/10.1097/brs.0000000000004134
Narain AS, Hijji FY, Duhancioglu G, Haws BE, Khechen B, Manning BT, Colman MW, Singh K (2018) Patient perceptions of minimally invasive versus open spine surgery. Clin Spine Surg 31:E184-e192. https://doi.org/10.1097/bsd.0000000000000618
Chen CM, Lin GX, Sharma S, Kim HS, Sun LW, Wu HH, Chang KS, Chen YC (2020) Suprapedicular retrocorporeal technique of transforaminal full-endoscopic lumbar discectomy for highly downward-migrated disc herniation. World Neurosurg 143:e631–e639. https://doi.org/10.1016/j.wneu.2020.08.038
He J, Tang J, Jiang X, Ren H, Cui J, Liang Z, Zhang J, Liang D (2020) Efficacy and safety of foraminoplasty performed using an endoscopic drill to treat axillary disc herniation. World Neurosurg 138:e413–e419. https://doi.org/10.1016/j.wneu.2020.02.143
Ahn Y, Kim CH, Lee JH, Lee SH, Kim JS (2013) Radiation exposure to the surgeon during percutaneous endoscopic lumbar discectomy: a prospective study. Spine 38:617–625. https://doi.org/10.1097/BRS.0b013e318275ca58
Iprenburg M, Wagner R, Godschalx A, Telfeian AE (2016) Patient radiation exposure during transforaminal lumbar endoscopic spine surgery: a prospective study. Neurosurg Focus 40:E7. https://doi.org/10.3171/2015.11.Focus15485
Fan G, Gu X, Liu Y, Wu X, Zhang H, Gu G, Guan X, He S (2016) Lower learning difficulty and fluoroscopy reduction of transforaminal percutaneous endoscopic lumbar discectomy with an accurate preoperative location method. Pain Physician 19:E1123-e1134
Hwa Eum J, Hwa Heo D, Son SK, Park CK (2016) Percutaneous biportal endoscopic decompression for lumbar spinal stenosis: a technical note and preliminary clinical results. J Neurosurg Spine 24:602–607. https://doi.org/10.3171/2015.7.Spine15304
Chen L, Zhu B, Zhong HZ, Wang YG, Sun YS, Wang QF, Liu JJ, Tian DS, Jing JH (2022) The learning curve of unilateral biportal endoscopic (UBE) spinal surgery by CUSUM analysis. Front Surg 9:873691. https://doi.org/10.3389/fsurg.2022.873691
Choi KC, Shim HK, Hwang JS, Shin SH, Lee DC, Jung HH, Park HA, Park CK (2018) Comparison of surgical invasiveness between microdiscectomy and 3 different endoscopic discectomy techniques for lumbar disc herniation. World Neurosurg 116:e750–e758. https://doi.org/10.1016/j.wneu.2018.05.085
Li M, Yang H, Yang Q (2015) Full-endoscopic technique discectomy versus microendoscopic discectomy for the surgical treatment of lumbar disc herniation. Pain Physician 18:359–363
Choi KC, Park CK (2016) Percutaneous endoscopic lumbar discectomy for L5–S1 disc herniation: consideration of the relation between the iliac crest and L5–S1 disc. Pain Physician 19:E301-308
Lee SH, Kang HS, Choi G, Kong BJ, Ahn Y, Kim JS, Lee HY (2010) Foraminoplastic ventral epidural approach for removal of extruded herniated fragment at the L5–S1 level. Neurol Med Chir 50:1074–1078. https://doi.org/10.2176/nmc.50.1074
Chen Z, Zhang L, Dong J, Xie P, Liu B, Wang Q, Chen R, Feng F, Yang B, Shu T, Li S, Yang Y, He L, Pang M, Rong L (2018) Percutaneous transforaminal endoscopic discectomy compared with microendoscopic discectomy for lumbar disc herniation: 1-year results of an ongoing randomized controlled trial. J Neurosurg Spine 28:300–310. https://doi.org/10.3171/2017.7.Spine161434
Zhou C, Zhang G, Panchal RR, Ren X, Xiang H, Xuexiao M, Chen X, Tongtong G, Hong W, Dixson AD (2018) Unique complications of percutaneous endoscopic lumbar discectomy and percutaneous endoscopic interlaminar discectomy. Pain Physician 21:E105-e112
Hoogland T, Schubert M, Miklitz B, Ramirez A (2006) Transforaminal posterolateral endoscopic discectomy with or without the combination of a low-dose chymopapain: a prospective randomized study in 280 consecutive cases. Spine 31:E890-897. https://doi.org/10.1097/01.brs.0000245955.22358.3a
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Chang, H., Xu, J., Yang, D. et al. Comparison of full-endoscopic foraminoplasty and lumbar discectomy (FEFLD), unilateral biportal endoscopic (UBE) discectomy, and microdiscectomy (MD) for symptomatic lumbar disc herniation. Eur Spine J 32, 542–554 (2023). https://doi.org/10.1007/s00586-022-07510-6