Surgical Management of Lumbar Disc Herniation in Elite Athletes: A Comparative Study of Microdiscectomy and Endoscopic Lumbar Discectomy

Background: Lumbar disc herniation (LDH) represents a frequent cause of low back and lower limb pain in elite athletes, and is associated with abstention from sports activities and impaired quality of life. Purpose: To comparatively evaluate the visual analog scale (VAS) and Short-Form 36 (SF-36) Health Survey Questionnaire in elite athletes subjected to transforaminal endoscopic lumbar discectomy (TELD) versus conventional microdiscectomy for surgical management of LDH. Study Design: Cohort study; Level of evidence, 3. Methods: A total of 62 elite athletes diagnosed with LDH were classified into 2 groups based on the performed intervention: microdiscectomy (Group A, n = 28 patients) or TELD (Group B, n = 34 patients). The procedure selected was based on the anatomic location of LDH. The primary outcome measure was the VAS score for lower limb pain (VAS-LP), while the secondary outcome measures were the VAS score for low back pain (VAS-BP), the SF-36 questionnaire for quality-of-life assessment, and hospitalization duration, return-to-play time, and complications. All outcome measures were evaluated at determined intervals during a 3-year follow-up analysis. Results: Baseline descriptive data were similar between the 2 groups. VAS-BP values were significantly higher in Group A throughout the entire follow-up. In contrast, VAS-LP and the overwhelming majority of SF-36 scores were significantly ameliorated in Group B at most follow-up checkpoints. Hospitalization duration and return-to-play time were significantly less in Group B, while the rate of return-to-play was 100% in both groups. No major perioperative complications were observed in either group. Conclusion: TELD represents a safe and effective alternative for the surgical management of LDH in elite athletes and may offer advantages over conventional microdiscectomy, primarily related to its minimal invasiveness. However, meticulous patient selection and the assessment of patients' expectations are of critical importance to identifying patients suitable for the TELD procedure, given the relative inadequacy of such data in the literature to date.