Outcome of percutaneous endoscopic surgery for management of lumbar disc herniation

Abstract

Background
Lumbar disc herniation is a leading cause of back and leg pain. While open surgery is effective, it carries risks of tissue damage and prolonged recovery. Percutaneous endoscopic discectomy (PED) offers a minimally invasive alternative. This study evaluates the clinical outcomes of PED, focusing on efficacy and safety through a comprehensive statistical analysis of demographic data, surgical results, and key clinical parameters.


Methods
A prospective study was conducted on 20 patients with single-level unilateral lumbar disc herniation treated via either the interlaminar (65%) or transforaminal (35%) approach at the Neurosurgery Department, Menoufia University Hospital, between October 2020 and October 2022. Patients were followed for six months postoperatively.


Results
The cohort comprised 65% males and 35% females, with a mean age of 37 years. The most affected levels were L5-S1 (50%) and L4-L5 (45%). Mean preoperative Visual analoug scale (VAS) scores were 3.47 for back pain and 7.44 for leg pain. Postoperatively, back pain VAS scores decreased to 2.79 at 2 weeks, 2.20 at 3 months, and 1.38 at 6 months (p < 0.05). Leg pain VAS scores improved to 3.07, 2.13, and 0.76, respectively (p < 0.001). The mean Oswestry Disability index (ODI) score improved from 62 preoperatively to 23 at 3 months and 17 at 6 months (p < 0.001). The complication rate was 10% (2 cases). Based on the Modified Macnab criteria, 85% of patients achieved excellent outcomes, and 15% had good outcomes, resulting in a 100% favorable outcome rate. The transforaminal approach, typically performed under local anesthesia, was associated with shorter hospital stays compared to the interlaminar approach under general anesthesia.
Representative cases included a female patient with Rt sciatica and L5/S1disc herniation on MRI, and a male patient with Lt sciatica and Lt L4/5 disc herniation on MRI.


Conclusion
Endoscopic discectomy is an effective and safe treatment for lumbar disc herniation, providing significant improvements in pain and disability. While the choice of surgical approach can influence early postoperative outcomes, both interlaminar and transforaminal techniques demonstrate comparable long-term efficacy.