Comparison of the Outcomes of Microendoscopic Discectomy Versus Full-Endoscopic Discectomy for the Treatment of L4/5 Lumbar Disc Herniation

Abstract

Study design: Retrospective Comparative Study.

Objectives: To compare the outcomes of microendoscopic discectomy (MED) versus full-endoscopic discectomy (FED) for treating L4/5 lumbar disc herniation (LDH).

Methods: A retrospective study was performed on patients with L4/5 LDH treated using MED (n = 249) or FED (n = 124). A 16-mm tubular retractor and endoscope was used for MED, while a 4.1-mm working channel endoscope was used for FED. Patient background and operative data were collected. The Oswestry Disability Index (ODI) and European Quality of Life-5 Dimensions (EQ-5D) scores were recorded preoperatively and at 1 and 2 years postsurgery.

Results: The background data of the two groups were similar. The mean operation times for MED and FED were 59.3 and 47.7 min (respectively), and the mean volumes of removed nucleus pulposus were .65 and 1.03 g, respectively. These differences were significant (P < .001). Six dural tears and one postoperative hematoma were observed in the MED group; none were observed in the FED group. During the follow-up period, 16 MED and 7 FED patients required re-operation due to recurrence (P = 1.00). Although the ODI and EQ-5D scores significantly improved at 1 and 2 years postsurgery in both groups, the differences were not statistically significant.

Conclusions: Operative outcomes were almost identical in both groups. We did not observe any operative or postoperative complications in FED. We, therefore, recommend FED as the first option for the treatment of L4/5 LDH since it has a better safety profile and is minimally invasive.

Keywords: L4/5; full-endoscopic discectomy; lumbar disc herniation; microendoscopic discectomy; minimally invasive.

Figure 1.

Flow diagram of the study design. Abbreviations: MED, microendoscope discectomy; FED, full-endoscopic discectomy.

Figure 2.

Preoperative radiographic findings on the characteristics of the LDH (LDH type, degree of migration, and size of LDH). (A) LDH is classified into three types according to the direction of herniation on the axial MRI: shoulder/ventral, central, and axilla types. A laterally compressed nerve root of the axilla type is indicated by the white arrow. (B) Schematic representation of the four anatomical migration zones and levels of LDH according to Lee’s classification. These zones cover an area from the inferior margin of the upper pedicle to the inferior margin of lower pedicle. (C) The size of the LDH is evaluated by measuring the protrusion height (D: white arrows) against the anteroposterior diameter of the spinal canal (D: gray arrows). Abbreviations: MRI, magnetic resonance imaging; LDH, lumbar disc herniation.