Although endoscopic discectomy is superior to microsurgical discectomy in terms of incision size, postoperative pain, and cosmetic appeal, the effectiveness and indications for endoscopic versus microsurgical discectomy remain active discussion topics. Due to the increasing incidence of discectomies being performed in Russia, further assessment of these techniques is needed. We performed a comparative analysis of long-term results of microsurgical, endoscopic, and endoscopically assisted microsurgical discectomies for patients with herniated lumbar discs.
The patient cohort included 131 patients who were enrolled in a prospective, randomized controlled study and 617 patients for whom data were gathered retrospectively. The quality of life was assessed using the Oswestry Disability Index (version 2.1a) and pain severity was analyzed using the visual analog scale for pain preoperatively; at discharge; and at 3, 6, and 12 months postoperatively.
Microsurgical, endoscopic, and endoscopically assisted microsurgical discectomies were all effective in relieving acute radicular symptoms. Recurrent disc herniation occurred more frequently after endoscopic discectomy than after the other approaches.
Our findings indicate that these three surgical techniques are highly effective and have similar clinical results at 1-year follow-up; however, due to the higher rate of herniation recurrence, only certain patients should undergo endoscopic discectomy. The endoscopically assisted discectomy technique allows for minimally invasive surgery while offering enhanced visualization of the anatomy that is hidden from view in microscopic procedures.