Recent clinical research has brought to light the effectiveness of two surgical approaches for treating dual-level lumbar disc herniation. A study published by researchers at Heibei Yiling Hospital compares the percutaneous endoscopic lumbar discectomy (PELD) with posterior lumbar interbody fusion (PLIF) for treating L4/5 and L5/S1 disc issues. This study aims to answer the pressing question: Is PELD less effective than PLIF for this specific condition?
With lumbar disc herniation (LDH) being prevalent, affecting approximately 9% of the global population, this comparison is of significant importance. Many patients fail conservative treatment, making surgical options necessary. Historically, surgical methods have included various techniques aimed at relieving nerve root compression; among these, PLIF has been widely adopted.
The researchers’ retrospective analysis included data from 40 patients treated between January 2020 and December 2021, 18 of whom underwent PELD, and 22 who opted for PLIF. The outcomes were measured at various intervals up to three years postoperatively using the visual analog scale (VAS), Oswestry disability index (ODI), and Japanese Orthopaedic Association (JOA) scores to provide insight on the effectiveness of each surgical method.
The findings of this study are telling. Within the first week after surgery, improvements were noted more significantly for the patients undergoing the PELD approach. According to the authors of the article, "the combination group was significantly more effective than the fusion group within one week after the operation." This initial difference was substantial, illustrating the benefits of PELD's less invasive nature and its quicker recovery profile.
Over the months, both surgical methods demonstrated improvements, with PELD showing notable advantages including less intraoperative bleeding, shorter operation time, and avoidance of general anesthesia. On evaluations using the modified MacNab criteria, the reported excellent or good outcomes were 94.44% for the PELD group and 90.91% for the PLIF group. This suggests both methods provide favorable results for patients dealing with dual-level LDH.
Throughout the follow-ups, patients from both groups expressed improvements, yet the PELD approach unveiled its strengths particularly within the initial recovery stage. The authors noted, "PELD has advantages in less intraoperative bleeding, shorter operation time, and non-general anesthesia,” reinforcing the method's appeal to both patients and surgeons.
Despite its quick recovery benefits, PELD carries the risk of postoperative recurrence, as reported with three cases of recurrence, two of which required reoperation. Conversely, the PLIF group experienced internal fixation failure and adjacent segment degeneration. This highlights the importance of surgeon decision-making when opting for either approach.
Surgeons face nuanced decisions as they weigh these findings. The article suggests, "surgeons should carefully weigh the advantages and disadvantages of the two operations,” illustrating the need for clinicians to tailor the surgical approach based on individual patient conditions and preferences. While both surgical procedures yielded satisfactory results, the differences suggest room for targeted discussions on expected outcomes following each method.
Future studies will be necessary to evaluate long-term effects more comprehensively. Given the relatively small sample size and the retrospective nature of this analysis, larger, controlled studies could clarify recurrence rates more effectively and define the optimal surgical strategies for treating lumbar disc herniation.
Within the rapidly advancing field of spinal surgery, such investigations encourage continual improvement of techniques and patient outcomes. Not only do they inform current practices but also lay groundwork for upcoming innovations aimed at bolstering recovery and efficiency within surgical care for lumbar disc conditions.