Comparative study of the efficacy and safety of minimally invasive interlaminar full-endoscopic discectomy versus conventional microscopic discectomy in single-level lumbar herniated intervertebral disc (ENDO-F Trial): a multicenter, prospective, randomized controlled trial protocol

Feasibility of Endoscopic Lumbar Discectomy in a Remote Government Hospital in Thailand: A Cost-Utility Analysis

BACKGROUND

Treatments for lumbar discectomy have developed over time. Recently, endoscopy has played an important role. However, a major obstacle to endoscopy in rural areas is the cost of surgery, particularly for endoscopes and disposable equipment. We assessed the cost effectiveness of endoscopic lumbar discectomy compared to the traditional open microdiscectomy technique in a government hospital in a developing country.

METHODS

This study focused on 50 patients who underwent endoscopic lumbar discectomy between April 2019 and March 2020 at Yala Regional Hospital and were reviewed by our team. The duration of hospital stays, operative time, follow-up, and clinical outcomes at one, three, and six months postoperatively were observed and compared with 30 patients who underwent microscopic lumbar discectomy. Hospital expenses were calculated and compared using t-tests.

RESULTS

Endoscopic discectomy was 4.00 days length of stay while microscopic discectomy has 9.77 days in averages. The pain score was 8.82 for endoscopic surgery and 9.1 for microscopic surgery. The operative price for the endoscopic discectomy was 144.69 USD higher than that for the open lumbar discectomy because of the disposable equipment. However, each patient in the microdiscectomy group had a longer hospital stay and required more perioperative care, which decreased the difference of the total hospital expenses (1,420.612 vs 1,399.16 USD).

CONCLUSION

Full endoscopic lumbar discectomy is an effective procedure that is beneficial for patients. The total hospital costs are not significantly different between the two procedures. To ensure that more patients receive this benefit and to develop surgical competency in government hospitals, the surgical reimbursement fee for endoscopic discectomy should be more affordable than that for conventional discectomy.

Percutaneous endoscopic interlaminar discectomy via inner border of inferior pedicle approach for downmigrated disc herniation: a retrospective study

Objective

To evaluate the efficacy and feasibility of percutaneous endoscopic interlaminar discectomy (PEID) via the inner border of the inferior pedicle approach for downmigrated disc herniation.

Methods

Seventeen patients who had downmigrated disc herniation were included in this study from May 2020 to February 2021. After PEID via the inner border of the inferior pedicle approach, a retrospective study was conducted on all patients. Radiologic findings were investigated, and based on the level of migration seen on preoperative magnetic resonance imaging (MRI), participants were divided into two types (high-grade and low-grade migrations). Preoperative, 1st post-operative day, 3rd post-operative month, and the final follow-up visual analogue scale (VAS) assessments for back and leg pain and preoperative, 3rd post-operative month, and the final follow-up Oswestry disability index (ODI) evaluations were performed. The clinical effects at the final follow-up were assessed by the modified MacNab criterion.

Results

All patients successfully completed surgery. There were 10 males and 7 females in the group. These patients were 42 years old on average (range, 25–68 years). Four and 13 patients had downmigrated disc herniation with high-grade and low-grade, respectively, on MRI. The mean follow-up duration was 10.47 ± 1.84 months (range, 8–14 months). The mean VAS score for back and leg improved from 5.18 ± 0.81 preoperatively to 1.35 ± 0.49 at the final follow-up (P < 0.05) and 6.94 ± 0.66 preoperatively to 1.47 ± 0.51 at the final follow-up (P < 0.05), respectively. The mean ODI score improved from 48.00 ± 3.64 preoperatively to 18.71 ± 1.31 at the final follow-up (P < 0.05). According to the modified MacNab criterion, 15 patients (88.2%) obtained excellent, while the rest 2 patients (11.8%) reported good outcomes.

Conclusion

PEID via the inner border of the inferior pedicle approach could be a good alternative option for the treatment of downmigrated disc herniation.