The Improvement of Back Pain and Radicular Pain Following Endoscopic Versus Microscopic Lumbar Discectomy: A Randomized Clinical Trial in an Egyptian Tertiary Care Center

Aims: To compare the results obtained from a cohort of patients with posterolateral lumbar disc prolapse regarding the postoperative improvement of back pain and radicular pain, in patients operated for endoscopic lumbar discectomy, with a group of patients operated for microscopic lumbar discectomy, in the Neurosurgery Department, Tanta University Hospitals, from November 2021 till the end of October 2022.

Methodology: A prospective analysis was performed on 40 patients operated for minimally invasive lumbar discectomy, 20 patients underwent microscopic discectomy and 20 patients underwent endoscopic discectomy. This randomized clinical trial took place in the Neurosurgery department, Tanta University Hospitals in Egypt.

Results: 40 patients with posterolateral single level de novo lumbar disc herniations were included. 20 patients underwent microscopic discectomy, and 20 patients underwent endoscopic discectomy. Both groups exhibited significant improvements in radicular and back pain postoperatively (P < 0.001). Although there was no significant difference in radicular pain improvement between the groups, improvement in back pain was significantly higher in the endoscopic group than in the microscopy group (5.1 ± 1.5 vs. 2.7 ± 1.0, P < 0.001). The improvement in Oswestry Disability Index (ODI) postoperative was statistically significant in both groups (P<0.001). Although statistically insignificant (P=0.072), the improvement in ODI was higher in the endoscopic group than in the microscopic group.

Conclusion: This study revealed that endoscopic lumbar discectomy is superior to microdiscectomy in terms of improvement of postoperative back pain, reduced hospital stay and early return to daily activity, which can be justified by the maximal preservation of normal bony and myoligamentous anatomy. This allows for earlier recovery and avoid chronic back pain resulting from fibrosis in muscles, ligaments and also epidural fibrosis.