A comparative study on the clinical efficacy of percutaneous transforaminal endoscopic discectomy versus fenestration discectomy for single-level lumbar disc herniation.

OBJECTIVE: To compare the clinical outcomes of percutaneous transforaminal endoscopic discectomy (PTED) with traditional fenestration discectomy (FD) for single-level lumbar disc herniation (LDH). METHODS: We retrospectively reviewed 368 patients with single-level LDH treated surgically between January 2019 and December 2021. Propensity score matching (PSM) was used to create balanced groups (n = 150 per group). Outcomes included clinical effectiveness (modified MacNab criteria), functional disability (ODI), pain severity (VAS), perioperative parameters, complications, and recurrence rates at 12 months. Analysis of covariance (ANCOVA) adjusting for preoperative scores was performed for primary functional outcomes. RESULTS: Clinical effectiveness at 12 months was higher in the PTED group (92.67% vs. 80.00%, P < 0.001). After adjusting for preoperative values, ODI scores at 12 months remained significantly lower in PTED patients (12.4 ± 5.1 vs. 25.8 ± 8.3, adjusted P < 0.001), as were VAS scores (1.1 ± 0.7 vs. 2.7 ± 1.0, adjusted P < 0.001). The PTED group showed reduced blood loss (55.8 ± 26.3 mL vs. 88.3 ± 39.4 mL, P < 0.001), shorter hospitalisation (1.5 ± 0.6 vs. 5.5 ± 0.6 days, P < 0.001), and lower complication rates (2.67% vs. 13.33%, P = 0.001). Recurrence at 12 months was 2.67% in PTED versus 8.67% in FD (P = 0.025). CONCLUSION: PTED offers favourable short-term clinical outcomes compared with open FD for single-level LDH, with less perioperative morbidity and lower early recurrence rates. Longer follow-up is needed to confirm durability of these results.