Comparative analysis of endoscopic discectomy for demanding lumbar disc herniation

Abstract

This study aimed to evaluate and compare the clinical effectiveness of two surgical techniques-unilateral biportal endoscopic (UBE) discectomy and percutaneous interlaminar endoscopic lumbar discectomy (IELD)-in addressing high-grade down-migrated lumbar disc herniation (HDM-LDH). A retrospective analysis was conducted on 39 patients with HDM-LDH who underwent surgical treatment between January 2020 and February 2023. This cohort included 18 patients in the UBE group and 21 patients in the IELD group. The two endoscopic techniques were compared based on operative time, intraoperative blood loss, hemoglobin decrease, C-reactive protein levels, and length of hospital stay. Efficacy was evaluated using the visual analog scale (VAS), Oswestry disability index (ODI), and modified MacNab criteria. The IELD group exhibited a shorter operative duration and reduced length of hospital stay, as well as diminished intraoperative blood loss compared to the UBE group (P < 0.05). No statistically significant differences were observed in the reduction of hemoglobin levels or the increase in C-reactive protein between the two groups (P > 0.05). Postoperatively, both groups experienced significant decreases in VAS scores and ODI scores relative to preoperative values. One day post-surgery, the VAS score for low back pain was higher in the UBE group than in the IELD group, with the difference being statistically significant (P < 0.05). However, no significant differences were found in the VAS scores for lower limb pain at any time point, nor in the ODI scores one day, one month, and three months post-surgery (P > 0.05). At the final follow-up, patient satisfaction rates were 94.44% in the UBE group and 95.24% in the IELD group, with no statistically significant difference (P > 0.05). One patient in the IELD group developed neurological symptoms following surgery. Both UBE and IELD demonstrate significant clinical efficacy in the treatment of HDM-LDH. The IELD technique is characterized by its minimally invasive nature, whereas UBE offers greater flexibility and a notably enhanced decompression effect. Clinicians are advised to select the appropriate technique based on individual patient conditions and specific clinical scenarios.

Keywords: High-grade down-migrated lumbar disc herniation; Percutaneous interlaminar endoscopic lumbar discectomy; Unilateral biportal endoscopic discectomy.

Fig. 1

Flowchart of study.

Fig. 2

UBE. (a–b) preoperative MRI demonstrated significant findings in both sagittal and transverse planes. Specifically, there was evidence of L5/S1 HDM-LDH, accompanied by pronounced compression of both the dural sac and adjacent nerve roots；(c) intraoperative lateral lumbar spine X-ray; (d–f) the microscope revealed a significant herniation of the nucleus pulposus. Following UBE treatment, nerve compression was alleviated；(g–h) postoperative MRI follow-up demonstrated complete removal of the herniated nucleus pulposus, with a satisfactory decompression outcome.

Fig. 3

IELD. (a–b) preoperative lumbar MRI demonstrated the presence of HDM-LDH at the L4/L5 level, exhibiting severe nerve root compression in both sagittal and transverse planes；(c) intraoperative lateral lumbar spine X-ray；(d–f) upon microscopic examination, a hill-shaped herniation of the nucleus pulposus was observed. Following IELD therapy, the compression exerted on the dural sac was alleviated；(g–h) postoperative MRI follow-up revealed the resolution of the herniated nucleus pulposus, with evidence of effective neural decompression.