Implementation of Percutaneous Transforaminal Endoscopic Discectomy in Competitive Elite Athletes With Lumbar Disc Herniation: Original Study and Review of the Literature

Abstract

Background: Lumbar disc herniation (LDH) represents a frequent clinical entity in athletes. Surgical treatment of LDH with endoscopic spine surgical techniques has been proposed as a feasible alternative in these patients.

Purpose: To study the particular outcomes of percutaneous transforaminal endoscopic discectomy (PTED) in competitive elite athletes with surgically treatable LDH.

Study design: Case series; Level of evidence, 4.

Methods: A total of 55 competitive elite athletes with diagnosed LDH based on clinical and radiologic criteria were enrolled in this prospectively designed study. All patients underwent successful PTED. Clinical evaluation was conducted with the well-established visual analog scale for lower limb and low back pain separately. The 36-Item Short Form Health Survey (SF-36) was implemented for health-related quality of life analysis. Patients were assessed preoperatively and at regular postoperative intervals: 6 weeks and 3, 6, and 12 months, as well as 2 years.

Results: Operated levels were L3-L4 (5.5%), L4-L5 (69.1%), and L5-S1 (25.4%). No major perioperative complications were observed. All patients successfully reached the end of follow-up at 2 years. Both visual analog scale scores (lower limb and low back pain) showed clinically and statistically significant improvement at 6 weeks postoperatively, with subsequent minor improvement and stabilization. All recorded SF-36 parameters demonstrated major clinical amelioration at 6 weeks, with subsequent minor but constant statistically significant improvement until the end of follow-up. Comparative evaluation of the SF-36 revealed that the physical function, bodily pain, role-emotional, and mental health parameters showed quantitatively greater improvement in comparison with rest indices.

Conclusion: PTED constitutes a feasible and effective technique for surgical management of LDH in athletes, providing favorable outcomes in terms of postoperative pain and health-related quality of life. Proper performance of technique for specific cases of L5-S1 LDH may be more challenging, and these cases should be evaluated selectively for suitability for this procedure.

Keywords: elite athletes; health-related quality of life; lumbar disc herniation; percutaneous transforaminal endoscopic discectomy.