Comparative Outcomes of Endoscopic vs. Open Lumbar Discectomy in Single-Level Disc Herniation

Abstract

Background: Lumbar disc herniation is the most common and a major reason for spinal surgery. Endoscopic lumbar discectomy and open discectomy are the choice of surgical treatment.

Objective: The aim of this study was to compare the outcomes of endoscopic versus open lumbar discectomy in single-level disc herniation.

Material and method: The current retrospective study was carried out at the orthopaedic department, Nowshera Medical College and Qazi Hussain Ahmad Medical Complex Nowshera. The study duration was one year from June 2023 to June 2024 after taking approval from the ethical committee of the hospital. 84 individuals with single-level LDH who had surgery at our institution were included in this study. 40 of them had Endoscopic Lumbar Discectomy (ELD), and 44 had Open Lumbar Discectomy (OLD). The visual analogue scale (VAS) was used to measure pain intensity before surgery after the procedure. Participants’ satisfactory responses were evaluated by the Macnab criterion.  The Mann-Whitney U test or the unpaired Student's t-test was used to analyze the continuous data. Statistical Software, version 16, was used to analyze all data. Fisher's exact test or the Chi-square test was used to evaluate categorical results. A p-value of less than 0.05 was considered statistically significant.

Results: A total of 84 individuals with single-level LDH were included in this study.44 individuals had done had open lumbar discectomy and 40 had endoscopic lumbar discectomy. The baseline data showed no statistically significant differences. The ELD group had a significantly lower mean, post-operative, surgical site pain VAS score than the OLD group, however, at 96 hours, there was no significant difference. The ELD group consumed a lower average amount of morphine.  The ELD group had a significantly shorter mean hospital stay than the OLD group ( p=0.003). There was no statistically significant difference among the ELD and OLD groups in McNab's outcome evaluation of patient satisfaction in terms of good to excellent (p=0.091). Hospital expenses were considerably greater in the ELD group, while OT was longer in the ELD group (99.5±28.5 minutes) than in the OLD group (p<0.001).

Conclusion: Our study concluded that endoscopic lumbar discectomy for single-level lumbar discectomy had shorter hospital stay, less opioid use, and less postoperative pain but more expenses as compared to open lumbar discectomy. The two groups' patient satisfaction results were similar.