ArticleOrthopaedic surgery2026
Comparative Efficacy of Posterior Versus Lateral Endoscopic Approaches in the Management of Complex Lumbar Disc Herniation: A Retrospective Cohort Study.
Article in Orthopaedic surgery, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
introductionComplex lumbar disc herniation (CLDH), including huge, migrated, and calcified variants, poses surgical challenges due to factors such as deep-seated lesions, irregular morphology, and adhesion to neural structures. This study aimed to compare the clinical outcomes of two minimally invasive endoscopic approaches-percutaneous endoscopic interlaminar discectomy (PEID) and percutaneous endoscopic transforaminal discectomy (PETD)-in the management of CLDH.
methodsIn this retrospective cohort study, 270 patients with CLDH treated between January 2020 and January 2024 were analyzed. Patients were categorized into three CLDH subtypes and were further divided into PEID and PETD groups based on preoperative imaging findings. Surgical parameters, perioperative data, and complications were recorded. Functional outcomes were evaluated using the visual analogue scale (VAS), Oswestry Disability Index (ODI), and modified MacNab criteria. Imaging measurements included the cross-sectional area of facet joints (CSA-FJ) and dural sac (DSCA). Statistical analyses were performed using the chi-square test, Wilcoxon rank-sum test, Shapiro-Wilk test, independent-samples t-test, and two-way repeated-measures ANOVA.
resultsAll procedures were successfully completed. PEID showed shorter operative time and significantly fewer fluoroscopy exposures compared to PETD (p < 0.05). PETD was associated with a higher facet joint resection rate (p < 0.05), though DSCA improvements were similar between groups. Both groups demonstrated significant reductions in VAS and ODI scores at all follow-up points (p < 0.05), with no statistically significant differences between approaches. Over 80% of patients achieved excellent or good outcomes according to modified MacNab grading. Complications were uncommon and included dural tears (n = 3), epidural hematoma (n = 1), nerve root injury (n = 1), and recurrent herniation (n = 2).
conclusionBoth PEID and PETD are effective and safe surgical options for treating CLDH. PEID offers reduced operative time and radiation exposure, while PETD requires more extensive facet resection. This study further outlines tailored surgical strategies for different CLDH subtypes, supporting individualized endoscopic treatment selection.
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