Retrospective Study of Minimal Three-Year Follow-Up of Transforaminal Endoscopic Discectomy for Lumbar Disc Herniation: 5000 Multicenter Cases

Chuanchao Du Sr; Kunfeng Song; Bao Hai; Xiangyu Wang

doi:10.7759/cureus.50993

Retrospective Study of Minimal Three-Year Follow-Up of Transforaminal Endoscopic Discectomy for Lumbar Disc Herniation: 5000 Multicenter Cases

Cureus. 2023 Dec 23;15(12):e50993. doi: 10.7759/cureus.50993. eCollection 2023 Dec.

Authors

Chuanchao Du Sr¹, Kunfeng Song², Bao Hai³, Xiangyu Wang⁴

Affiliations

¹ Orthopedic Surgery, Emergency General Hospital/National Emergency Medicine Research Center, Beijing, CHN.
² Center of Minimal Invasive Spine Surgery, Henan People's Third Hospital, Zhengzhou, CHN.
³ Orthopedic Surgery, Peking University Third Hospital, Beijing, CHN.
⁴ Pain Department, People's Liberation Army General Hospital, Beijing, CHN.

Abstract

Objective The objective of this study was to investigate the long-term effects of percutaneous transforaminal endoscopic lumbar discectomy (PTELD) and clarify the differences between outside-in and inside-out techniques. Methodology This was a multicenter retrospective study with a chart review of questionnaires about patients' quality of life. Patients were recruited from three hospitals in China. Based on certain inclusion and exclusion criteria, we enrolled in the study 5000 patients aged ≥18 years diagnosed with lumbar disc herniation who received PTELD from September 2015 to September 2019. The outside-in technique (n=2039) was compared with the inside-out technique for PTELD (n=1890) on the Visual Analogue Scale (VAS), Oswestry Disability Index (ODI), and the Short Form 36 (SF-36) of the Health Survey Questionnaire (physical component) both pre-operatively and post-operatively. Results VAS, ODI, and SF-36 significantly improved just after surgery for both techniques compared with pre-operative status. Nevertheless, significant differences existed between the two techniques concerning VAS for leg pain, VAS for back pain, ODI, and SF-36 at 0.5 months post-operatively. The above indices steadily improved within six months after both techniques, after which they did not significantly improve. In detail, outside-in patients suffered more back pain and worse ODI and SF-36 (physical) but had more relief from leg pain 0.5 months after surgery in terms of VAS. As for recovery rate from symptoms, there were only significant differences in recovery rate for leg pain and back pain at the first 1.5 months post-operatively. As for satisfaction rates, the outside-in technique had better results than the inside-out technique at both 0.5 months and 12 months. Conclusion Both techniques could relieve the symptoms of lumbar disc herniation. However, patients in the outside-in group suffered more back pain and a bigger risk of nerve injury than those in the inside-out group.

Keywords: inside-out; outside-in; percutaneous transforaminal endoscopiclumbar discectomy (pteld); quality of life; retrospective study.