Microendoscopic discectomy combined with annular suture versus percutaneous transforaminal endoscopic discectomy for lumbar disc herniation: A prospective observational study

Abstract

Background: Microendoscopic discectomy (MED) and percutaneous transforaminal endoscopic discectomy (PTED) are 2 of the most popular minimally invasive spinal surgery techniques. We are investigating whether minimally invasive early annular closure can achieve a better clinical effect in the treatment of lumbar disc herniation (LDH). Objective: To compare the clinical and imaging outcomes between MED combined with annular suture and PTED in the treatment of LDH. Study Design: A prospective observational study with follow-up of 36 months. Setting: The First People’s Hospital of Lianyungang in China. Methods: A total of 135 prospective consecutive patients underwent MED + annular suture or PTED. Patients were assessed postoperatively at 3 days and 3, 6, 12, 24, and 36 months. The outcome measures were visual analog scales for back pain (VAS-back) and leg pain (VAS-leg) scores, the Oswestry Disability Index (ODI) score, the Medical Outcomes Study 36-Item Short-Form Health Survey bodily pain (SF36-BP), and physical function (SF36-PF) scales, disc height, and recurrence rate. Results: One hundred and six patients have completed the 3-year follow-up. The operation time and length of stay in the MED + annular suture group were longer than that in the PTED group (P < 0.001 and P < 0.001). VAS-back score, VAS-leg score, ODI score, SF36-BP, and SF36-PF significantly improved at follow-up time points after surgery compared to before surgery, but no significant differences were found at postoperative and 36 months between the groups. The disc height in the MED + annular suture group was significantly greater than that in the PTED group after 3 months. Within 36-month follow-up, imaging re-herniation was reported in 4 patients in the MED + annular suture group, and 9 patients in the PTED group (P = 0.170). Symptomatic re-herniation occurred in one patient in the MED + annular suture group and in 4 patients in the PTED group (P = 0.190). Limitations: First, this was not a randomized controlled trail, which could provide more evidencebased conclusions. Second, we did not accurately measure and compare the amount of nucleus pulposus removed, although less nucleus pulposus was removed in MED + annular suture. Conclusion: PTED has the advantages of shorter length of incision, shorter operation time, and shorter length of stay. MED + annular suture is associated with greater preservation of disc height, and showed certain advantages of lower recurrence rate, although there was no statistical difference.