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  • Title: Microendoscopic Discectomy Combined with Annular Suture Versus Percutaneous Transforaminal Endoscopic Discectomy for Lumbar Disc Herniation: A Prospective Observational Study.
    Author: Ren C, Qin R, Li Y, Wang P.
    Journal: Pain Physician; 2020 Nov; 23(6):E713-E721. PubMed ID: 33185390.
    Abstract:
    BACKGROUND: Microendoscopic discectomy (MED) and percutaneous transforaminal endoscopic discectomy (PTED) are 2 of the most popular minimally invasive spinal surgery techniques. We are investigating whether minimally invasive early annular closure can achieve a better clinical effect in the treatment of lumbar disc herniation (LDH). OBJECTIVE: To compare the clinical and imaging outcomes between MED combined with annular suture and PTED in the treatment of LDH. STUDY DESIGN: A prospective observational study with follow-up of 36 months. SETTING: The First People's Hospital of Lianyungang in China. METHODS: A total of 135 prospective consecutive patients underwent MED + annular suture or PTED. Patients were assessed postoperatively at 3 days and 3, 6, 12, 24, and 36 months. The outcome measures were visual analog scales for back pain (VAS-back) and leg pain (VAS-leg) scores, the Oswestry Disability Index (ODI) score, the Medical Outcomes Study 36-Item Short-Form Health Survey bodily pain (SF36-BP), and physical function (SF36-PF) scales, disc height, and recurrence rate. RESULTS: One hundred and six patients have completed the 3-year follow-up. The operation time and length of stay in the MED + annular suture group were longer than that in the PTED group (P < 0.001 and P < 0.001). VAS-back score, VAS-leg score, ODI score, SF36-BP, and SF36-PF significantly improved at follow-up time points after surgery compared to before surgery, but no significant differences were found at postoperative and 36 months between the groups. The disc height in the MED + annular suture group was significantly greater than that in the PTED group after 3 months. Within 36-month follow-up, imaging re-herniation was reported in 4 patients in the MED + annular suture group, and 9 patients in the PTED group (P = 0.170). Symptomatic re-herniation occurred in one patient in the MED + annular suture group and in 4 patients in the PTED group (P = 0.190). LIMITATIONS: First, this was not a randomized controlled trail, which could provide more evidence-based conclusions. Second, we did not accurately measure and compare the amount of nucleus pulposus removed, although less nucleus pulposus was removed in MED + annular suture. CONCLUSION: PTED has the advantages of shorter length of incision, shorter operation time, and shorter length of stay. MED + annular suture is associated with greater preservation of disc height, and showed certain advantages of lower recurrence rate, although there was no statistical difference.
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