Transforaminal versus interlaminar endoscopic approach for broad-based lumbar disc herniation under standardized postoperative mecobalamin therapy: a retrospective comparative study based on VAS and ODI.

Objective: This study aims to compare the clinical outcomes of the transforaminal approach (TFA) and interlaminar approach (ILA) for broad-based lumbar disc herniation (BLDH) under a standardized postoperative mecobalamin regimen. The primary focus is on dynamic changes in Visual Analog Scale (VAS) pain scores and Oswestry Disability Index (ODI) outcomes. Methods: This retrospective study included 184 patients with single-segment BLDH treated between June 2023 and October 2024 (89 in the TFA group and 95 in the ILA group). Both groups received the same postoperative mecobalamin regimen. Outcomes included the prespecified primary outcome of VAS score at 3 months postoperatively, as well as secondary outcomes including ODI, operative parameters, modified MacNab efficacy, neurological function, complications, and quality of life. Multivariable-adjusted analyses were performed to reduce potential selection bias. Results: Compared with TFA, ILA was associated with lower VAS scores at 3 months postoperatively (the prespecified primary outcome) and lower ODI at 3 days postoperatively (both Conclusion: Under the same standardized postoperative mecobalamin treatment background, ILA is associated with better early postoperative recovery than TFA in patients with BLDH. These findings primarily reflect differences between the two surgical approaches rather than an independent effect of mecobalamin.