Comparing Clinical Outcomes of Microdiscectomy, Interspinous Device Implantation, and Full-Endoscopic Discectomy for Simple Lumbar Disc Herniation

Chien-Ching Lee; Ruey-Mo Lin; Wei-Sheng Juan; Hao-Yu Chuang; Hung-Lin Lin; Cheng-Hsin Cheng; Chun-Hsu Yao

doi:10.3390/jcm14061925

Comparing Clinical Outcomes of Microdiscectomy, Interspinous Device Implantation, and Full-Endoscopic Discectomy for Simple Lumbar Disc Herniation

J Clin Med. 2025 Mar 13;14(6):1925. doi: 10.3390/jcm14061925.

Authors

Chien-Ching Lee^{1

2}, Ruey-Mo Lin³, Wei-Sheng Juan⁴, Hao-Yu Chuang^{4

5}, Hung-Lin Lin⁶, Cheng-Hsin Cheng^{4

7}, Chun-Hsu Yao^{8

9

10

11}

Affiliations

¹ Department of Anesthesia, An Nan Hospital, China Medical University, Tainan 70965, Taiwan.
² Department of Medical Sciences Industry, Chang Jung Christian University, Tainan 71101, Taiwan.
³ Department of Orthopedics, An Nan Hospital, China Medical University, Tainan 70101, Taiwan.
⁴ Department of Neurosurgery, An Nan Hospital, China Medical University, Tainan 70965, Taiwan.
⁵ Department of Neurosurgery, China Medical University Beigang Hospital, Yunlin 65152, Taiwan.
⁶ Department of Neurosurgery, China Medical University Hospital, Taichung 40447, Taiwan.
⁷ Graduate Institute of Medical Sciences, Chang Jung Christian University, Tainan 71101, Taiwan.
⁸ Department of Biomedical Imaging and Radiological Science, China Medical University, Tainan 70965, Taiwan.
⁹ School of Chinese Medicine, China Medical University, Tainan 70965, Taiwan.
¹⁰ Biomaterials Translational Research Center, China Medical University Hospital, Taichung 40447, Taiwan.
¹¹ Department of Biomedical Informatics, Asia University, Taichung 41354, Taiwan.

Abstract

Background/Objectives: The treatment for lumbar disc herniation (LDH) is surgical discectomy. This surgery may enhance spinal instability and exacerbate disc degeneration. The most common treatment options include microdiscectomy (MD), interspinous process device (IPD) implantation, and percutaneous endoscopic lumbar discectomy (PELD). As few studies have compared these three procedures, this study focused on collecting data on the clinical, functional, and imaging outcomes of surgery for symptomatic LDH. Methods: This is a retrospective, transverse, and analytical study, with a total of 383 patients who received operations for symptomatic LDH between 2018 and 2022. Medical information from the charts of these patients was collected. The results were followed up on for a minimum of one year by collecting responses from several questionnaires and clinical data, including patients' scores on the visual analogue scale (VAS), Oswestry Disability Index (ODI), and symptomatic improvement score (SIS), as well as wound size, blood loss, hospital stay, postoperative disc change, and complications. Results: At the end of data collection, the VAS and ODI scores all showed significant improvement following these three procedures (p < 0.01). The SISs were all ranked as good (8.1, 8.5, and 7.9) post-surgery. PELD was a minimally invasive procedure that resulted in the smallest wound size (0.82 cm), minimal blood loss (21 mL), and a short hospital stay (4.2 days). A substantial pre-/postoperative change in disc height was noted in the MD (-17%) and PELD (-15%) groups. The complication rates were similar among the three groups (3%, 5%, and 5.6%). Conclusions: IPD implantation and PELD yielded outcomes comparable to those of conventional MD for symptomatic relief and functional recovery. Although the complication rates were similar, the postoperative complications were quite different from those of the other procedures. PELD resulted in rapid recovery and minimal invasion, and IPD implantation showed a good ability to preserve disc height and spinal stability; however, the clinical relevance of these findings in disc degeneration remains controversial.

Keywords: degenerative disc disease; discectomy endoscopic; interspinous process devices; lumbar disc herniation; microdiscectomy; percutaneous endoscopic lumbar discectomy.

Grants and funding

This work was supported by the Tainan Municipal An-Nan Hospital, China Medical University (ANHRF111-49), and China Medical University (CMU111-S-03, CMU112-S-02).