Percutaneous Transforaminal Endoscopic Discectomy Versus Microendoscopic Discectomy for Lumbar Disk Herniation: Five-year Results of a Randomized Controlled Trial

Zihao Chen; Liangming Zhang; Jianwen Dong; Peigen Xie; Bin Liu; Ruiqiang Chen; Shangfu Li; Zhongyu Liu; Bu Yang; Feng Feng; Lei He; Yang Yang; Mao Pang; Limin Rong

doi:10.1097/BRS.0000000000004468

Percutaneous Transforaminal Endoscopic Discectomy Versus Microendoscopic Discectomy for Lumbar Disk Herniation: Five-year Results of a Randomized Controlled Trial

Spine (Phila Pa 1976). 2023 Jan 15;48(2):79-88. doi: 10.1097/BRS.0000000000004468. Epub 2022 Sep 7.

Authors

Zihao Chen^{1

2

3}, Liangming Zhang^{1

2

3}, Jianwen Dong^{1

2

3}, Peigen Xie^{1

2

3}, Bin Liu^{1

2

3}, Ruiqiang Chen^{1

2

3}, Shangfu Li^{1

2

3}, Zhongyu Liu^{1

2

3}, Bu Yang^{1

2

3}, Feng Feng^{1

2

3}, Lei He^{1

2

3}, Yang Yang^{1

2

3}, Mao Pang^{1

2

3}, Limin Rong^{1

2

3}

Affiliations

¹ Department of Spine Surgery, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
² Guangdong Provincial Center for Quality Control of Minimally Invasive Spine Surgery, Guangzhou, China.
³ Guangdong Provincial Center for Engineering and Technology Research of Minimally Invasive Spine Surgery, Guangzhou, China.

PMID: 36083850
DOI: 10.1097/BRS.0000000000004468

Abstract

Study design: A prospective randomized controlled study.

Objective: To compare the efficacy and safety between percutaneous transforaminal endoscopic discectomy (PTED) and microendoscopic discectomy (MED).

Summary of background data: Two kinds of minimally invasive discectomy, PTED and MED, are now widely used for treating lumbar disk herniation (LDH). The long-term comparative results of these two techniques still remained uncertain.

Materials and methods: In this single-center, open-label, randomized controlled trial, patients were included if they had persistent signs and symptoms of radiculopathy with corresponding imaging-confirmed LDH and were randomly allocated to PTED or MED groups. The primary outcome was the score of Oswestry Disability Index (ODI) and the secondary outcomes included the score of Medical Outcomes Study 36-Item Short-Form Health Survey bodily pain (SF36-BP) and physical function (SF36-PF), European Quality of Life-Five Dimensions (EQ-5D), Visual Analog Scales for back pain (VAS-back) and leg pain (VAS-leg).

Results: A total of 241 patients were accepted to enroll in our randomized controlled trial, of which 119 were randomly assigned to the PTED group, and the rest 122 were assigned to the MED group. A total of 194 out of 241 patients (80.5%) completed the five-year follow-up. PTED group was associated with shorter postoperative in-bed time and length of hospital stay. Both primary and secondary outcomes did not differ significantly between the two treatment groups at each follow-up time point. During the five-year follow-up, seven recurrent cases occurred in PTED and MED groups, respectively.

Conclusion: Over the five-year follow-up period, PTED and MED were both efficacious in the treatment of LDH. The long-term clinical outcomes and recurrent rates were comparable between the treatment groups. PTED represents a more minimally invasive technique with the advantages of rapid recovery.

Trial registration: ClinicalTrials.gov NCT01997086.

Publication types

Randomized Controlled Trial

MeSH terms

Back Pain / surgery
Diskectomy / methods
Diskectomy, Percutaneous* / methods
Endoscopy / methods
Humans
Intervertebral Disc Displacement* / surgery
Lumbar Vertebrae / surgery
Prospective Studies
Quality of Life
Retrospective Studies
Treatment Outcome

Associated data

ClinicalTrials.gov/NCT01997086