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. 2024 Dec 30;20(2):269-277.
doi: 10.1055/s-0044-1801376. eCollection 2025 Jun.

A Comparative Outcome of Full Endoscopic Lumbar Discectomy for L4/5 Central-Paracentral Disc Herniation: Interlaminar versus Transforaminal Approach: A 2-Year Prospective Randomized Controlled Follow-Up Study

Pritsanai Pruttikul  1 , Tinnakorn Pluemvitayaporn  1 , Palapat Ananpipatkij  1 , Kinzang Dorji  1 , Sombat Kunakornsawat  1 , Suttinont Surapuchong  1   2 , Warot Ratanakoosakul  1 , Kitjapat Tiracharnvut  1 , Chaiwat Piyasakulkaew  1 , Piyabuth Kittithamvongs  2
Affiliations

A Comparative Outcome of Full Endoscopic Lumbar Discectomy for L4/5 Central-Paracentral Disc Herniation: Interlaminar versus Transforaminal Approach: A 2-Year Prospective Randomized Controlled Follow-Up Study

Pritsanai Pruttikul et al. Asian J Neurosurg. .

Abstract

Background The interlaminar and transforaminal approaches are commonly employed in full endoscopic lumbar spine surgery. Both approaches are well-suited for addressing specific types of lumbar disc herniation, particularly at the L4/5 level. Objective This article compares the clinical outcomes of full endoscopic discectomy for L4/5 central-paracentral disc herniation between the interlaminar and transforaminal approaches. Materials and Methods Sixty patients were randomly assigned to either a full endoscopic interlaminar discectomy group or a full endoscopic transforaminal discectomy group, with 30 patients each. The procedures were performed by a single spine surgeon at our institution between 2017 and 2019. Over a 2-year follow-up period, various parameters, including operative time, postoperative hospitalization duration, Visual Analog Scale (VAS) scores for leg and back pain, Oswestry Disability Index (ODI), and modified MacNab criteria, were assessed and compared between the two groups. Additionally, the complication rates were documented. Results The two full endoscopic approaches resulted in significant improvements in back-leg pain measured by the VAS and in the ODI scores postsurgery. A comparison between the two approaches revealed a significant difference in the ODI score at the 6-week postoperative mark ( p = 0.02). However, other clinical outcome parameters did not show significant differences at the other follow-up time points. Postoperative dysesthesia was more prevalent in patients who underwent endoscopic transforaminal discectomy ( p < 0.05). The operative time was notably longer for the interlaminar approach compared with the transforaminal approach (62.6 ± 18.0 vs. 37.0 ± 13.6). Postoperative hospitalization time did not exhibit significant differences between the two groups. Conclusion Both the interlaminar and transforaminal approaches demonstrate similar clinical outcomes in treating central-paracentral L4/5 disc herniation. Each technique presents distinct advantages and disadvantages regarding operative time and postoperative dysesthesia. The full endoscopic interlaminar and transforaminal approaches have proven to be safe and effective methods for addressing L4/5 central-paracentral disc herniation.

Keywords: discectomy; full endoscope; interlaminar approach; lumbar disc herniation; transforaminal approach.

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Conflict of interest statement

Conflict of Interest None declared.

Figures

Fig. 1
Fig. 1
The magnetic resonance imaging (MRI) images depict a 31-year-old male with a 2-month history of left leg pain ( A , B ) and a 34-year-old male with a 6-month history of left leg pain ( E , F ). The endoscopic views display an interlaminar approach revealing a free fragment disc ( C ) and a transforaminal approach showing a free fragment disc ( G ), followed by images postdiscectomy ( D , H ).
Fig. 2
Fig. 2
The endoscopic interlaminar approach is illustrated in the model for the treatment of L4/5 disc herniation, showcasing the location of the working sleeve.
Fig. 3
Fig. 3
The endoscopic transforaminal approach is being utilized for the treatment of L4/5 disc herniation. The model illustrates the precise location of the working sleeve.
Graph 1
Graph 1
Comparison of Visual Analog Scale (VAS) leg pain between the two groups.
Graph 2
Graph 2
Comparison of Visual Analog Scale (VAS) back pain between the two groups.
Graph 3
Graph 3
Comparison of Oswestry Disability Index (ODI) score between the two groups.
See this image and copyright information in PMC

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References

    1. Mayer H M. A history of endoscopic lumbar spine surgery: what have we learnt? BioMed Res Int. 2019;2019(02):4.583943E6. - PMC - PubMed
    1. Phan K, Xu J, Schultz K et al. Full-endoscopic versus micro-endoscopic and open discectomy: a systematic review and meta-analysis of outcomes and complications. Clin Neurol Neurosurg. 2017;154:1–12. - PubMed
    1. Kim M, Lee S, Kim H-S, Park S, Shim S-Y, Lim D-J. A comparison of percutaneous endoscopic lumbar discectomy and open lumbar microdiscectomy for lumbar disc herniation in the Korean: a meta-analysis. BioMed Res Int. 2018;2018:9.07346E6. - PMC - PubMed
    1. Pruttikul P, Chobchai W, Pluemvitayaporn T, Kunakornsawat S, Piyaskulkaew C, Kittithamvongs P. Comparison of post-operative wound pain between interlaminar and transforaminal endoscopic spine surgery: which is superior? Eur J Orthop Surg Traumatol. 2022;32(05):909–914. - PubMed
    1. Ruetten S, Komp M, Merk H, Godolias G. Full-endoscopic interlaminar and transforaminal lumbar discectomy versus conventional microsurgical technique: a prospective, randomized, controlled study. Spine. 2008;33(09):931–939. - PubMed

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