Original ArticleComparison of MED and PELD in the Treatment of Adolescent Lumbar Disc Herniation: A 5-Year Retrospective Follow-Up
Introduction
Adolescent lumbar disc herniation (ALDH) constitutes 0.6%–6.8% of all cases of lumbar disc herniation (LDH).1, 2 Gulati et al.3 used data from the Norwegian Registry for Spine Surgery to compare the efficacy and safety of microdiscectomy in adolescents and adults with LDH and found similar surgical outcomes and complication rates in the 2 groups.3 To date, however, minimally invasive methods have not been reported for the treatment of patients with ALDH.
Microendoscopic discectomy (MED), one of the prevailing surgical techniques for the treatment of LDH, was first described by Foley and Smith in 19974 and is becoming increasingly popular among spine surgeons. Numerous studies have confirmed its effectiveness and safety even when used to treat recurrent lumbar disc herniation.5, 6, 7 One meta-analysis on the efficacy and safety of MED concluded that the procedure provides long-term improvement in leg pain equivalent to that from open discectomy; however, the analysis did not evaluate the efficacy of MED in relieving lower back pain.8
Percutaneous endoscopic lumbar discectomy (PELD) was first described by Yeung et al.9 in 2002, and soon attracted the attention of many spine surgeons. In a 10-year follow-up study, Eun et al.10 found that PELD can effectively resolve both lower back pain and radicular pain with no disc height loss. Yoon et al.11 reported similar clinical outcomes and low complication rates in patients who underwent MED and those who underwent PELD.
To date, however, no study has explored the surgical outcomes of patients with ALDH. Here we report a 5-year retrospective follow-up of patients with ALDH who underwent MED or PELD at our hospital, focusing on outcomes and safety of the 2 procedures.
Section snippets
Patients
We retrospectively reviewed patients age <21 years with LDH who were treated in our department between January 2010 and January 2012. The patients were screened using history and physical examination findings, and the diagnosis of ALDH was confirmed by lumbar disc magnetic resonance imaging. The inclusion criteria were (1) diagnosis of LDH with no improvement after 6–8 weeks of conservative treatment, (2) age <21 years, (3) surgery with either MED or PELD, and (4) surgery performed by a senior
Results
A total of 80 patients met our criteria and were enrolled in our study. As a result, 30 cases and 48 cases were analyzed for the MED and PELD groups, respectively. The numbers of surgery for each involved surgeons were shown in Table 1. The mean duration of follow-up was 67.07 ± 6.76 months in the MED group and 68.87 ± 7.03 months in the PELD group. There were no significant between-group differences in age, sex, and body mass index (P > 0.05) (Table 2).
Perioperative data, including duration of
Discussion
Our findings indicate that both MED and PELD are effective treatments for ALDH. After surgery, patients from both groups reported less lower back and leg pain, as well as improved quality of life. The patients in the MED group reported more severe lower back pain. PELD provided superior leg pain relief at 1 week after surgery, but long-term pain relief was similar in the 2 procedures.
Adolescent was a special group with several characteristics. First, the structure of the intervertebral disc
Conclusions
In this midterm retrospective study, we found that PELD and MED provided equivalent relief of radicular pain and improved quality of life in the short term for adolescents with ALDH, but PELD was more advantageous for lower back pain.
References (22)
- et al.
Prospective comparison of microsurgical, tubular-based endoscopic, and endoscopically assisted diskectomies: clinical effectiveness and complications in railway workers
World Neurosurg
(2016) - et al.
Lumbar disc herniation in adolescence
Pediatr Neurosurg
(2007) - et al.
Histological study of lumbar intervertebral disc herniation in adolescents
Acta Neurochir (Wien)
(2000) - et al.
Lumbar microdiscectomy for sciatica in adolescents: a multicentre observational registry-based study
Acta Neurochir (Wien)
(2017) - et al.
Microendoscopic discectomy
Tech Neurosurg
(1997) - et al.
Tubular diskectomy vs conventional microdiskectomy for the treatment of lumbar disk herniation: 2-year results of a double-blind randomized controlled trial
Neurosurgery
(2011) - et al.
Minimally invasive tubular microdiscectomy for recurrent lumbar disc herniation
J Neurosurg Spine
(2016) - et al.
Microendoscopic discectomy (MED): the first 100 cases
Neurosurgery
(1998) - et al.
The efficacy of minimally invasive discectomy compared with open discectomy: a meta-analysis of prospective randomized controlled trials
J Neurosurg Spine
(2012) - et al.
Posterolateral endoscopic excision for lumbar disc herniation: surgical technique, outcome, and complications in 307 consecutive cases
Spine (Phila Pa 1976)
(2002)
Long-term follow-up results of percutaneous endoscopic lumbar discectomy
Pain Physician
Cited by (36)
Minimum 2-Year Efficacy of Percutaneous Endoscopic Lumbar Discectomy versus Microendoscopic Discectomy: A Meta-Analysis
2020, World NeurosurgeryCitation Excerpt :Although previous studies supported that PELD could achieve less blood loss,23 no difference was found in our meta-analysis because of the small sample size and high heterogeneity. The operative time for the 2 groups reported in previous studies was inconsistent.13-21 Shi et al.23 found that with the development of proficiency in surgical skills, the operative time of PELD was becoming shorter, which might be related to the learning curve effects.25
Surgical management of lumbar disc herniation in children and adolescents
2019, Clinical Neurology and NeurosurgeryCitation Excerpt :The majority of recent publications report endoscopic approaches and there is a need for more modern outcome data of microdiscectomy, and research designed specifically to establish the place of microdiscectomy alongside minimally invasive techniques. Comparing tubular to PED, a retrospective study found no difference in ODI or leg pain at final follow-up [39]. PED, however, resulted in a greater decrease in LBP at final follow-up and a faster improvement in leg pain and ODI.
Comparison of one-hole split endoscopic discectomy and microendoscopic discectomy in the treatment of lumbar disk herniation: a one-year retrospective cohort study
2024, Journal of Orthopaedic Surgery and Research
Conflict of interest statement: The authors declare that the article content was composed in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.