Liu Sen, Zhao Feng, Yin Chun-Ping, Zhu Chao-Hua, Zhao Ruo-Yu, Liu Guo-Bin, Ji Gang, Chen Jia, Gao Hong-Yang
Department of Orthopedics, The First Hospital of Hebei Medical University, Shijiazhuang, China.
Front Surg. 2025 Feb 19;12:1554970. doi: 10.3389/fsurg.2025.1554970. eCollection 2025.
This study aimed to compare the mid-term outcomes and patient satisfaction between percutaneous endoscopic lumbar discectomy (PELD) and microendoscopic discectomy (MED) for the treatment of foraminal and extraforaminal lumbar disc herniations.
A retrospective matched cohort study was conducted, including patients diagnosed with foraminal or extraforaminal lumbar disc herniations who underwent PELD or MED between January 2014 and December 2021. Patient demographics, clinical characteristics, and perioperative data were analyzed. Primary outcomes included Visual Analog Scale (VAS) scores for pain, Japanese Orthopaedic Association (JOA) scores and improvement rates for functional status, and overall satisfaction at a minimum 2-year follow-up.
A total of 133 patients were included in the final analysis. The PELD group demonstrated a significantly greater reduction in VAS scores for low back pain (6.74 ± 1.21 to 1.95 ± 0.42) compared to the MED group (6.93 ± 1.17 to 2.35 ± 0.89) at the 2-year follow-up ( < 0.001). Both groups exhibited significant improvements in JOA scores, with no notable differences observed at the final follow-up. Patient satisfaction rates were higher in the PELD group, with 86% reporting high satisfaction compared to 72% in the MED group; however, this difference was not statistically significant. Logistic regression analysis identified VAS scores for low back pain, operation cost, and symptom recurrence as independent factors influencing patient dissatisfaction at 2 years post-surgery.
Both PELD and MED demonstrated efficacy in treating foraminal and extraforaminal lumbar disc herniations over a 2-year follow-up period. PELD, however, exhibited superior relief of low back pain. Factors, such as low back pain intensity, surgical costs, and symptom recurrence significantly impacted patient dissatisfaction, despite comparable overall satisfaction rates between the two surgical techniques.
本研究旨在比较经皮内镜下腰椎间盘切除术（PELD）和显微内镜下椎间盘切除术（MED）治疗椎间孔型和椎间孔外型腰椎间盘突出症的中期疗效和患者满意度。
进行一项回顾性匹配队列研究，纳入2014年1月至2021年12月期间接受PELD或MED治疗的椎间孔型或椎间孔外型腰椎间盘突出症患者。分析患者的人口统计学资料、临床特征和围手术期数据。主要结局包括疼痛视觉模拟量表（VAS）评分、日本骨科协会（JOA）评分及功能状态改善率，以及至少2年随访时的总体满意度。
最终分析共纳入133例患者。在2年随访时，PELD组下腰痛VAS评分较MED组显著降低（从6.74±1.21降至1.95±0.42，而MED组从6.93±1.17降至2.35±0.89）（P<0.001）。两组JOA评分均有显著改善，末次随访时未观察到明显差异。PELD组患者满意度更高，86%的患者报告高度满意，而MED组为72%；然而，这种差异无统计学意义。逻辑回归分析确定下腰痛VAS评分、手术费用和症状复发是影响术后2年患者不满意的独立因素。
在2年随访期内，PELD和MED治疗椎间孔型和椎间孔外型腰椎间盘突出症均有效。然而，PELD在下腰痛缓解方面表现更优。尽管两种手术技术的总体满意度相当，但下腰痛强度、手术费用和症状复发等因素显著影响患者的不满意程度。
