Changes in Back Pain After Percutaneous Endoscopic Lumbar Discectomy and Annuloplasty for Lumbar Disc Herniation: a Prospective Study

Objective: Percutaneous endoscopic lumbar discectomy and annuloplasty (PELDA) is a minimally invasive spinal technique for lumbar disc herniation. Following discectomy, the relief of leg pain is common; however, the relief of back pain is less predictable. The purpose of this study was to evaluate changes in back pain and to examine the predisposing factors for postoperative back pain following PELDA.

Design: In this prospective study, 58 patients with leg and back pain associated with disc herniation underwent PELDA. The patients were divided into two groups: unfavorable and favorable. Patients were defined as having unfavorable outcomes if the percentage improvement of back pain <50% or the postoperative Oswestry Disability Index (ODI) >20% at postoperative 24 months. The preoperative demographic, clinical, and radiologic factors for each group were statistically analyzed.

Results: Fifty-two patients were enrolled in this study. The mean visual analog scale scores for back pain and the ODI scores significantly improved from 6.6 and 55.9% preoperatively to 2.5 and 12.7% at the 24-month follow-up. The surgical satisfaction rate was 78.4% at the final follow-up. Eighteen (34.6%) patients had unfavorable outcomes. Patients with advanced disc degeneration of operative levels had significantly worse outcomes than those with mild disc degeneration (odds ratio: 6.316, 95% confidence interval 1.25-31.86, P < 0.05). The severity of postoperative back pain was negatively correlated with surgical satisfaction (correlation coefficient: -0.564, P = 0.00).

Conclusion: PELDA can relieve back pain as well as leg pain through direct decompression and thermal ablation of the annular defect. Disc degeneration can be expected to influence clinical outcomes following PELDA.