Endoscopic Discectomy Versus Nonsurgical Management for Extruded or Sequestrated Lumbar Disc Herniation: A Retrospective Cohort Study With Minimum 2-Year Follow-Up

Study Design Retrospective cohort study. Objectives This study aimed to compare the clinical efficacies of endoscopic surgery and nonsurgical treatment in patients with extruded or sequestered lumbar disc herniation (LDH). Population 613 patients with extruded or sequestrated LDH were included (endoscopic: n = 276; nonsurgical: n = 337). Methods Patients received either endoscopic discectomy or structured nonsurgical management. Longitudinal VAS and ODI trajectories were analyzed using linear mixed-effects models. Return to work (RTW) outcomes were evaluated using Kaplan–Meier survival curves and Cox proportional hazards models. Spearman correlation was used to assess the association between resorption and symptom improvement. Results Both cohorts had comparable sex, BMI, and herniation levels ( P > .05), but differed in age ( P < .001), which did not influence outcomes after adjustment. VAS and ODI improved in both groups over time ( P < .001). Endoscopic discectomy provided faster symptom relief within 6 months ( P < .001), whereas mid to long-term outcomes were comparable between groups ( P > .05). Disc resorption occurred in 58.2% of nonsurgical patients (median time 6.9 months). Resorption was correlated with greater improvements in ODI and VAS ( P < .05). Surgical complications included transient neurological deficits (17.4%), dural tears (1.1%), and epidural hematomas (0.7%). Postoperative recurrence occurred in 8.3% of patients. RTW time was unaffected by treatment, sex, BMI, or herniation level ( P > .05), but was influenced by age (HR = 0.948, P < .001) and occupational demands (HR = 0.697, P < .001). Conclusions Endoscopic discectomy provides faster early pain and functional improvement (≤6 months), while nonsurgical management achieves comparable outcomes thereafter. Disc resorption contributes to symptom recovery. RTW time is determined primarily by age and occupational demands.