Clinical comparison of unilateral biportal endoscopic technique with interlaminar microdiscectomy for single-level lumbar discectomy: a prospective study

Background. Positive clinical outcomes of microdiscectomy vary in the range from 75 to 80 %. However, the share of unsatisfactory results with more than 2-year follow-up is 38 %, and with 8-year follow-up it reaches 40 %. To avoid postoperative fibrosis, which in the future may require repeated surgical intervention, and to improve the outcomes of surgical treatment for disc herniations, the traumatic approach is to be reduced. In this regard, endoscopic lumbar discectomy is the least invasive direct decompression technology and a promising direction of surgical treatment for herniated intervertebral discs. Materials and methods. A prospective study was conducted on the basis of the neurosurgery department of the spine and spinal cord of the Ivano-Frankivsk Regional Clinical Hospital. The criteria for intergroup distribution were the methods of surgical treatment: patients of the first group (n = 57) underwent removal of a herniated intervertebral disc by the method of unilateral biportal endoscopic discectomy, participants of the second group (n = 60) underwent open interlaminar microdiscectomy. Results. No significant differences were found in the intergroup comparison according to the Oswestry Disability Index at all stages. The duration of surgery when using endoscopic access averaged 41 minutes [38.5; 44.75] vs 60 min [57.5; 69.65] with microdiscectomy, the difference is statistically significant (р ≤ 0.01). The volume of blood loss was 2.3 times less during endoscopic access — 53.1 ± 19.7 ml and 121.5 ± 18.4 ml (р < 0.05). As expected, the length of stay in the hospital was shorter in the endoscopic discectomy group — 2 days [1; 3] versus 4 days [3; 6] in the microdiscectomy group (p ≤ 0.05), which is associated with early activation of patients, less pain syndrome, correspondingly smaller size of postoperative wound and no need for wound care. Conclusions. The results of our research showed the potential advantages of unilateral biportal endoscopic discectomy over interlaminar microdiscectomy.