Introduction: Percutaneous endoscopic lumbar discectomy (PELD) is regarded as an effective treatment option for soft lumbar disc herniation. The purpose of this study was to demonstrate the long-term outcomes of PELD comparing with those of conventional open microdiscectomy.
Methods: A total of 298 consecutive patients with soft lumbar disc herniation were treated with decompressive discectomy. Among them, 146 patients were treated with PELD, and the remaining 152 patients were treated with conventional microdiscectomy. Clinical data were compared with a 5-year follow-up period. Clinical outcomes were evaluated using the visual analogue scale (VAS), Oswestry Disability Index (ODI), modified Macnab criteria and return to ordinary work.
Results: The pain scores and functional outcomes of the two groups were similar. The mean VAS score for back pain improved from 5.07 to 1.91 in the PELD group and from 5.01 to 1.76 in the Open group. The mean VAS score for radicular pain improved from 6.57 to 1.44 in the PELD group and from 6.58 to 1.32 in the Open group. The mean ODI improved from 63.59 to 13.89 in the PELD group and from 67.04 to 13.13 in the Open group. The rate of excellent or good outcomes was 87.7% for the PELD group and 93.4% for the Open group. The overall patient satisfaction was also similar (89.7% vs. 92.8, respectively). The reoperation rate was 4.2% in the PELD group and 3.3% in the Open group (P > 0.05). The PELD group had significantly shorter operation time, hospital stay and time to recovery (P < 0.05).
Conclusions: The long term effect of PELD for soft disc herniation is comparable to conventional open microdiscectomy. The selective endoscopic discectomy showed typical advantages of minimally invasive procedures such as shorter operation time, shorter hospital stay, and earlier return to ordinary life.
Patient Care: The long-term outcome of percutaneous endoscopic lumbar discectomy under strict inclusion criteria is as effective as open microdiscectomy. It may offer typical advantages of minimally invasive spinal surgery such as less tissue trauma and earlier recovery.
Learning Objectives: By the conclusion of this session, participants should be able to: 1) describe the importance of minimally invasive spinal technique for lumbar disc disease, 2) discuss about the long-term outcome of percutaneous endoscopic lumbar discectomy, 3) Identify an effective treatment option for soft lumbar disc herniations with minimal tissue damage and short recovery time.