Open lumbar microdiskectomy versus transforaminal percutaneous endoscopic lumbar diskectomy in treatment of lumbar disc herniation

Objective To compare the clinical outcomes of open lumbar microdiskectomy (OLM) versus transforaminal percutaneous endoscopic lumbar discectomy (PELD) for lumbar disc herniation (LDH). Methods Clinical data about 72 patients with one level lumbar disc herniation admitted to Air Force Hospital,Central Theatre Command from March 2012 to March 2016 were retrospectively analyzed.There were 32 patients in OLM group,including 15 males and 17 females,with average age of (49.31±10.48) years and follow up period of (32.59±11.00) months.Another 40 patients were in PELD group,including 23 males and 17 females,with average age of (53.40±13.16) years and follow up period of (33.08±12.88) months.Surgical level,operating duration (min),blood loss (ml),hospital stay (d),surgery related complications and revision surgery were recorded.Visual Analog Scale of lower limbs (VAS-L),Visual Analog Scale of back (VAS-B) and Oswestry Disability Index (ODI) at preoperation,1 day after operation and last follow up were also recorded. Results There was no statistically significant difference in inter-group comparison of general characteristics or perioperative indicators,except that hospital stay (1.60±0.74 d vs 2.50±0.67 d) and blood loss (24.05±11.03 ml vs 47.75±12.79 ml) showed more satisfactory result in the PELD group.VAS and ODI were improved at 1 day after operation and last follow up in both groups (P<0.05).The PELD group was superior to the OLM group in terms of VAS-B (1.95±0.71 vs 2.34±0.86,P<0.05) at 1 day after operation,and no statistically significant difference was found in inter-group comparison of VAS-L or ODI at any other time points.Four patients received revision operation in the PELD group and no one in the OLM group did.No statistically significant difference was found in comparison of complication rate or revision rate. Conclusion Both OLM and PELD are effective method for LDH,with similar clinical outcome.However,PELD has advantage over OLM in hospital stay,blood loss and pain relieving,while revision rate is higher in the PELD group.