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Corresponding Author

Ahmed Ismail, MD.

Authors ORCID

0009-0005-3432-178X

Subject Area

Degenerative, Lumbosacral spine, Minimally invasive procedures

Article Type

Original Study

Abstract

Background Data: Percutaneous endoscopic transforaminal discectomy (PETD) has become a widely used minimally invasive spine procedure that can be done under local anesthesia but enables direct visualization of the nerve tissue and prolapsed disc. There is controversy concerning the cons and pros of its two main approaches, the posterolateral entry (PLE) approach and the facet line entry (FLE) approach.

Purpose: This study aims to compare the effectiveness of PETD-PLE versus PETD-FLE in treating L4/L5 posterolateral grade I and II disc prolapse with or without disc extrusion.

Study Design: A prospective nonrandomized cohort clinical case study.

Methods: A total of 200 patients with L4/L5 disc prolapse participated in this investigation. The patients were allocated into two groups: Group I, PETD-PLE; Group II, PETD-FLE. The operative time, operative fluoroscopy exposure, hospital stay, Visual Analogue Scale (VAS) of leg pain, and Oswestry Disability Index (ODI) were compared between the two groups preoperatively and three months postoperatively.

Results: In the PLE group, the operative time, operative fluoroscopy exposure, and hospital stay were 1.80 ± 0.82 hours, 58.5 ± 20.6 seconds, and 17.7 ± 6.59 hours, respectively. In contrast, in the FLE group, the values were 1.40 ± 0.48 hours, 52.5 ± 21.5 seconds, and 18 ± 6.16 hours, respectively. Meanwhile, leg pain VAS and ODI showed no statistically significant differences in both groups preoperatively and three months postoperatively.

Conclusion: Both PETD-PLE and PETD-FLE techniques provide similar results in patients with L4/L5 posterolateral disc prolapse grades I and II and the choice depends on thesurgeon’s preference.

Keywords

percutaneous endoscopic transforaminal discectomy, foraminotomy, minimally invasive surgery, lumbar disc disease

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