Comparative Study between Full-Endoscopic Discectomy and Microendoscopic Discectomy for the Treatment of Lumbar Disc Herniation

• Main Authors: Muneyoshi Fujita, Tomoaki Kitagawa, Masahiro Hirahata, Takahiro Inui, Hirotaka Kawano, Hiroki Iwai, Hirohiko Inanami, Hisashi Koga
• Format: Article
• Language: English
• Published: MDPI AG 2020-12-01
• Series: Medicina
• Subjects: lumbar disc herniation; full-endoscopic spine surgery; discectomy; minimally invasive; radiculopathy; low back pain
• Online Access: https://www.mdpi.com/1010-660X/56/12/710

<i>Background and objectives</i>: Lumbar disc herniation (LDH) is a common disease in the meridian of life. Although surgical discectomy is commonly used to treat LDH, there are several different strategies. We compared the outcomes of uniportal full-endoscopic discectomy (FED) with those of microendoscopic discectomy (MED) in treating LDH. <i>Materials and Methods</i>: FED was performed using a 4.1-mm working channel endoscope, and MED was performed using a 16-mm diameter tubular retractor and endoscope. Data of patients with LDH treated with FED (<i>n </i>= 39) or MED (<i>n </i>= 27) by the single surgeon were retrospectively reviewed. Patient background information and operative data were collected. Pre- and postoperative low back and leg pain were evaluated using the numerical rating scale (NRS) score. Pre- and postoperative disc height index (DHI) values were calculated from plain radiographs, and the disc height loss was evaluated using the ratio (DHI ratio); <i>Results</i>: The median (interquartile range (IQR) Q25–75) operation times for FED and MED were 42 (33–61) and 43 (33–50) minutes, respectively. The median (IQR Q25–75) pre- and postoperative NRS scores for low back pain were 5 (2–7) and 1 (0–4), respectively, for FED and 6 (3–8) and 1 (0–2), respectively, for MED. The median (IQR Q25–75) pre- and postoperative NRS scores for leg pain were 7 (5–8) and 0 (0–2), respectively, for FED and 6 (5–8) and 0 (0–2), respectively, for MED. These data were not different between the FED and MED groups. The median (IQR Q25–75) DHI ratios of FED and MED were 0.94 (0.89–1.03) and 0.90 (0.79–0.95), respectively. The DHI ratio was significantly higher (<i>p</i> < 0.05) in the FED group than in the MED group, and there was less blood loss; <i>Conclusions</i>: The pain-relieving effect of FED in treating LDH was almost identical to that of MED. However, FED was superior to MED in preventing disc height loss, which is one of the indicators of postoperative disc degeneration.