Comparative analysis of operative time, blood loss, and X-ray parameters: Two-dimensional navigation guided percutaneous endoscopic transforaminal discectomy vs. conventional microscopic surgery for lumbar disc herniation

This retrospective comparative study aims to evaluate the clinical efficacy of two-dimensional (2D) navigation-guided percutaneous endoscopic transforaminal discectomy in comparison to conventional microscopic surgery for the treatment of lumbar disc herniation (LDH), based on operative time, blood loss, and X-ray examination parameters. Clinical data of patients who underwent either 2D navigation-assisted endoscopic (2D-NAE) discectomy or conventional microscopic surgery for LDH were retrospectively reviewed. Baseline characteristics, perioperative data, clinical outcomes (including visual analog scale [VAS] scores, Oswestry Disability Index [ODI] scores, and Modified MacNab criteria), and complications were compared between the two groups. A total of 95 patients were included, with 80 having complete follow-up data. The 2D navigation group comprised 47 patients, while the conventional microscopic surgery group had 33 patients. Both groups showed significant improvement in VAS and ODI scores at each follow-up time point (P < 0.05). The perioperative analysis favored the 2D navigation-assisted group, with a significantly shorter operative time (42.77 ± 7.56 vs. 59.33 ± 3.30 min; p < 0.01) and lower blood loss (10.34 ± 2.24 vs. 11.55 ± 2.20 ml; p = 0.02). The number of X-ray examinations required was similar between the two groups (2.34 ± 0.48 vs. 2.39 ± 0.56; p = 0.65), and post-operative hospitalization durations were comparable (p = 0.5). Clinical efficacy, as reflected by VAS scores for legs and ODI scores, showed no significant differences between the groups. Additionally, the Modified MacNab criteria indicated similar rates of excellent and good outcomes. Both 2D-NAE discectomy and conventional microscopic surgery demonstrated comparable therapeutic outcomes for LDH, with favorable clinical efficacy and safety profiles. However, 2D-NAE surgery may offer additional benefits, including shorter operative times, reduced blood loss, and fewer X-ray examinations.