Abstract
Background: Minimally invasive surgery includes percutaneous endoscopic lumbar discectomy and the microscopic tubular technique. This study aimed to compare the two techniques and evaluate the outcomes of the procedures.Methods: We retrospectively analyzed patients with far-lateral lumbar disc herniation (FLLDH) from June 2015 to October 2018. Twenty-six patients underwent paraspinal muscle-splitting microscopic-assisted discectomy (MD) and 30 patients underwent percutaneous endoscopic lumbar discectomy (PELD) surgery by the same surgical team. Data included the duration of the operation, duration of intraoperative radiation exposure, and average duration of hospitalization. Pre- and postoperative pain scores and neurological functions were recorded using a visual analog scale (VAS) score and Oswestry disability index (ODI).Results: 56 patients remained in the study over the 12–24 months period. The mean operating time was 65.83 ± 16.64 min in the PELD group, mean duration of radiation exposure was 2.87 ± 1.19 min, and average of hospitalization was 3.43 days. The mean operating time was 44.96 ± 16.87 min in the MD group, duration of radiation exposure was 0.78 ± 0.32 min, and duration of hospitalization was 4.12 days. There were two patients with postoperative transient dysesthesia and one underwent reoperation 7 months after surgery in the PELD group. One patient had postoperative transient dysesthesia in the MD group. Except low back pain at 3 months (p >0.05), all patients in both groups showed significant improvement in VAS and ODI scores compared with pre-operation and until final follow-up (p<0.05). Although the learning curve of MD is shorter compared with the PELD, beginners should practice on cadavers and receive teaching demonstrations from senior surgeons.Conclusion: Both techniques are minimally invasive, effective, and safe for treating far-lateral lumbar disc herniation in selected patients. Compared with the PELD technique, the MD procedure offers a wider field of vision during operation, shorter operation time, fewer postoperative complications, and shorter learning curve.
Far lateral lumbar disc herniation part 1: Imaging, neurophysiology and clinical features
