Clinical Outcomes of Percutaneous Transforaminal Endoscopic Discectomy Versus Fenestration Discectomy in Patients with Lumbar Disc Herniation

Background: Fenestration discectomy (FD) is a common treatment method for lumber disc herniation (LDH), with good effects obtained. Nevertheless, it also causes many complications, such as lumbar instability, lumbago and back pain. Percutaneous endoscopic lumbar discectomy (PTED) is a new minimally invasive treatment available for LDH with conservative therapy failure. At present, this technique has been carried out in China. The purpose of this study was to conduct a randomized prospective trial to compare the surgical outcomes of PTED and FD, explore the clinical application value of PTED, and discuss the operative manipulated skills of PTED.Methods: Totally 100 patients with LDH were enrolled from March 2014 to December 2015 and randomly divided into PTED group and FD group, 50 cases in each group. FD group received FD including epidural anesthesia, unilateral fenestration decompression, removal of nucleus pulposus, and nerve root decompression and release, while FTED group received PTED including local anesthesia, endoscopic removal of herniated nucleus pulposus and nerve root decompression and release. Both groups were followed up postoperatively. The duration of operation, incision length, postoperative bed-rest and hospital stay were compared between two groups, and the visual analogue scale (VAS), Oswestry disability index (ODI), and therapeutic effects at the final follow-up time were recorded and compared between 2 groups.Results: All patients completed the operation successfully. The surgical duration was similar between two groups (P>0.05). PTED group showed a less incision length and shorter postoperative bed-rest time and hospital stay than FD group (P<0.01). The VAS and ODI scores showed a significant decrease in both groups postoperatively when compared with operation before (P<0.05), but with no significant difference between two groups (P>0.05). Moreover, the excellent and good rate was higher in PTED group thanin FD group, with no statistical difference between them ((90.0% vs. 90.0%, Z=-1.113, P=0.266)).Conclusion: Both FD and PTED are effective in the treatment of LDH. However, PTED is superior to FD due to smaller incision, shorter postoperative hospital stay, less affect on spinal instability and faster recovery, thus the long-term outcomes deserve to be further studied