Early clinical outcomes of percutaneous endoscopic lumbar discectomy for L4-5 highly down-migrated disc herniation: interlaminar approach versus transforaminal approach

Abstract Objective This study retrospective evaluation of patients with L4-5 highly down-migrated lumbar disc herniation (LDH) operated with interlaminar endoscopic lumbar discectomy (IELD) versus transforaminal endoscopic lumbar discectomy (TELD). Methods From January 2015 to December 2018,77 patients with L4-5 highly down-migrated LDH were divided into two groups according to different surgical approaches. There were 40 patients underwent IELD, and 37 patients underwent TELD. The operation time, hospital stay, Oswestry Disability Index (ODI), clinical outcome according with modified MacNab criteria, visual analog scale (VAS) scores, and complications were compared between the IELD group and TELD group. Results 77 patients were included, 40 and 37 patients underwent IELD and P TELD, respectively. The IELD group and TELD group both achieved a significant improvement in ODI, back VAS score and leg VAS score, clinical outcome post-operation. Mean operating time and X-ray times during operation were significantly shorter in IELD group than in TELD group (41.8 vs 50.3, 1.8 vs 13.7). There were 3 patients experienced recurrence in IELD group and 2 in TELD group. In the TELD group, there were 3 patients required revision surgery due to incompletely removed of disc fragment. All patients in IELD group were treated successfully. There was no other complication in these cases. Conclusions Both IELD and TELD could be a good alternative option for highly down-migrated LDH in L4-L5, IELD may have advantages in operation time and X-ray times during operation compared with TELD.