Comparison Between Interlaminar and Transforaminal Endoscopic Lumbar Discectomy for Sciatic Scoliosis Secondary to Lumbar Disc Herniation: A Retrospective Study With a Minimum 1 Year Follow‐Up

ABSTRACT Objective This study aims to compare the clinical and radiographic outcomes of interlaminar and transforaminal endoscopic lumbar discectomy (IELD and TELD) in the treatment of lumbar disc herniation (LDH) with sciatic scoliosis. Methods Patients with sciatic scoliosis secondary to LDH who had undergone IELD or TELD between January 2022 to June 2024 were reviewed. Radiographic parameters, including Cobb angle, apical vertebral translation (AVT), and coronal balance distance (CBD), were measured preoperatively and postoperatively to assess curve evolution. Clinical outcomes were evaluated using the Visual Analog Scale (VAS) and the Oswestry Disability Index (ODI). Meanwhile, perioperative data were also collected. Comparisons between the groups were made by independent t ‐tests and χ 2 tests. Results A total of 134 patients in the IELD group and 103 patients in the TELD group were included in this study. There was no significant difference in intraoperative blood loss (13.4 ± 7.8 mL vs. 11.5 ± 7.1 mL, p = 0.067) and postoperative length of stay (2.5 ± 0.6 days vs. 2.5 ± 0.8 days, p = 0.378) between the two groups; however, the IELD group demonstrated shorter operation time (87.2 ± 17.4 min vs. 96.1 ± 23.3 min, p = 0.001) and fewer intraoperative fluoroscopy times (4.9 ± 0.7 vs. 10.3 ± 2.7, p < 0.001) compared to the TELD group. Both groups showed significant improvements in VAS and ODI scores ( p < 0.05), with no significant differences between the groups. Before surgery, 86.9% (206/237) patients had a disc herniation at the convex side of the lumbosacral curve and 86.5% (205/237) patients showed a trunk shift toward the opposite side of disc herniation. After surgery, 91.8% (123/134) of the IELD group and 90.3% (93/103) of the TELD group achieved resolution of scoliosis (AVT ≤ 10 mm) within 12 months. At the final follow‐up, the AVT, Cobb angle, CBD, and SVA in the IELD group were 2.7 ± 2.0 mm, 1.0° ± 0.8°, 1.2 ± 0.9 mm, and 3.4 ± 3.1 mm, respectively, with no significant differences compared to the 2.8 ± 2.7 mm, 1.1° ± 0.8°, 1.2 ± 0.8 mm, and 3.7 ± 3.5 mm in the TELD group. Conclusions Both IELD and TELD are effective and safe for LDH with sciatic scoliosis, with comparable radiographic and clinical outcomes in terms of scoliosis correction. IELD is associated with shorter operation time and fewer intraoperative fluoroscopy times in this cohort.