Comparation of Percutaneous Endoscopic Lumbar Discectomy between Transforaminal Approach and Interlaminar Approach on Lumbar Disc Herniation of L4-L5: An Observational Study

Objective: To evaluate the clinical outcomes and complications of post percutaneous endoscopic lumbar discectomy (PELD) via transforaminal (TF) approach and interlaminar (IL) approach in patients with lumbar disc herniation L4-L5 level. Materials and Methods: Eighty-five patients diagnosed with lumbar disc herniation on L4-L5 level and who underwent PELD were non-randomly recruited and assigned into two groups. Fifty-two patients underwent PELD via the IL approach and thirty-three patients underwent PELD via the TF approach. The demographic data, resting visual analog scale (VAS), activity VAS, Oswestry Disability Index (ODI), and complications were obtained before the operation, and at follow-up on day 1, and at 2-, 6-, 12-, and 24-months post operation. Results: Resting VAS and activity VAS statistically significantly declined in both groups (p=0.001). Activities of daily living (ADL) as assessed by ODI increased significantly in both groups (p=0.001). However, there was no significant differences between the groups. The TF approach group had significant more dysesthesia and re-surgery (p=0.009, p=0.05, respectively) than the IL approach group. The total re-surgery rate during the two years of follow-up was in the 9.4%. Conclusion: PELD is a safe and effective minimal invasive spine surgery. The clinical results via both approaches have similar result but PELD via the TF approach had higher post-operative complications than via the IL approach. Additionally, PELD via the TF approach required higher skill to puncture and there is a steeper learning curve than PELD via the IL approach. Keywords: Percutaneous endoscopic lumbar discectomy, PELD, Transforaminal, Interlaminar