Article Type
Original Study
Abstract
Background:\ Lumbar disc herniation (LDH) is a major cause of radicular pain, and surgical decompression remains the standard treatment for persistent symptoms. Microscopic Discectomy (MD) has long been considered the gold standard of minimally invasive spine surgery, offering high success rates with reduced trauma compared to open surgery. However, Percutaneous Transforaminal Endoscopic Discectomy (PTED) represents a less invasive approach, minimizing muscle dissection and preserving bony structures. The comparative long-term efficacy and specific advantages between these two popular techniques remain a critical point of clinical debate. Methods:\ In this prospective randomized study, patients with single-level contained lumbar disc herniation (n = 80) were randomized to undergo either PTED or MD. Clinical outcomes were assessed using the Visual Analog Scale (VAS) for leg and back pain and the Oswestry Disability Index (ODI) at baseline, 6 hours post-op, at 1 months, 3 months, and 1-year post-surgery. Improvement was determined by reduced pain medication requirements and lower ODI scores. Lumbar Magnetic Resonance Imaging (MRI) was performed at 3 months post-intervention if indicated. Perioperative data, including operative time, length of hospital stay, radiation exposure and complication rates were also recorded and compared Results:\ There was no statistically significant difference between the two groups with regard to VAS for leg pain and back pain at the end of the 1-year follow-up. Back pain was significantly lower in PTED group at 6 hours post-operatively (1.90 ± 0.59 vs 3.28 ± 0.78; p < 0.001), with no significant difference thereafter. Mean operative time was 76.55 ± 8.96 minutes in PTED group versus 59.33 ± 12.78 minutes in MD group. Mean hospital stay was 18.60 ± 6.05 h in PTED group versus 37.8 ± 17.7 h in MD group. ODI improved from 57.60 ± 11.49 to 27.0 ± 15.12 in PTED group and from 58.75 ± 13.24 to 23.75 ± 12.85 in MD group at 1 year (p = 0.289). Radiation exposure was 52.10 ± 5.84 s in PTED group versus 0.63 ± 0.49 s in MD group. There was no statistically significant difference in the rate of complications. Conclusion: MD is a reliable gold standard, but PTED represents a significant advancement in the management of LDH by achieving equivalent radicular relief with significantly less post-operative back pain and shorter hospital stays, PTED aligns with the modern neurosurgical goal of maximal decompression through minimal access. While we must remain alert regarding radiation risks and the steep learning curve, the clinical evidence suggests that PTED is a safe and effective day-case procedure that can be performed under local anesthesia
Keywords
Percutaneous transforaminal endoscopic discectomy, Microscopic discectomy, Lumbar disc herniation, Minimally invasive spine surgery
How to Cite This Article
Daghedy, Mohamed Magdy; Elwany, Amr; Moussa, Wael Mohamed; and Yehia, Ahmed
(2026)
"Percutaneous Transforaminal Endoscopic Discectomy Versus Microscopic Discectomy for Management of Lumbar Disc Prolapse,"
Advanced Spine Journal: Vol. 45
:
Iss.
1
, Article 3.
Available at: https://doi.org/10.57055/2974-4822.1334
