Effect of Patient's Characteristics and Surgical Technique on the Patient Outcomes and Satisfaction After Endoscopic Lumbar Discectomy-A Long-Term Retrospective Study

Background: Percutaneous endoscopic lumbar discectomy (PELD) is a minimally invasive surgical technique for the treatment of lumbar disc herniation. Despite its growing popularity, limited research has explored the influence of patient characteristics and the choice of technique on post-operative outcomes and patient satisfaction. Objective: To investigate the impact of patient characteristics and surgical technique (interlaminar vs. transforaminal) on the surgical outcomes and patient satisfaction following PELD. Methods: A retrospective analysis was conducted on 177 patients who underwent PELD (53.1% males, age = 46.11 +/- 14.2 years), including 147 patients with the interlaminar approach and 30 with the transforaminal approach. Demographic data, pre-operative clinical features, surgical technique, intra-operative and post-operative complications and complaints, patient-reported outcomes (disability, quality of life, satisfaction), and revision surgery rates were documented and analyzed. The mean follow-up duration was 5.55 years +/- 2.73 years. Results: No significant differences were observed in demographics, pre-operative status, or post-operative complaints and complication rates between two surgical techniques, except that transforaminal technique showed a higher incidence for dural tear and persistent muscle weakness (p = 0.028 and p = 0.046, respectively). Both techniques led to excellent patient-reported outcomes with no significant differences. Total patient satisfaction with PELD was 93.8%, which correlated positively with the absence of complications and complaints and negatively with persistent back pain, recurrent herniation and revision surgery. Conclusions: Interlaminar and transforaminal PELD are both effective and safe minimally invasive surgical techniques for the treatment of lumbar disc herniation with a high patient satisfaction rate. Further prospective studies are warranted to confirm these findings.