Comparison of a progressive bone drilling system and a visualized reaming system in percutaneous transforaminal endoscopic discectomy: a comparative study.

Abstract

Percutaneous transforaminal endoscopic discectomy (PTED) is an alternative, minimally invasive procedure for the treatment of symptomatic lumbar disc herniation (LDH). Two foraminoplasty techniques exist, however, insufficient literature exists highlighting the differences between these procedures. A multicentre retrospective study was conducted in consecutive patients diagnosed with symptomatic LDH who received PTED at spine centres from March 2015 to June 2019. A total of 798 patients were recruited, of whom 432 underwent progressive bone drilling system (PBDS) for foraminoplasty and 366 received a visualized reaming system (VRS). The average radiation exposure and operative time in the PBDS group were significantly greater than those in the VRS group (P < 0.05). Compared with those before the operation, the postoperative VAS and ODI scores in both groups were significantly improved (P < 0.05). Additionally, the VAS score for leg pain and the JOA/ODI score in the PBDS group were significantly lower than those in the VRS group at both the 1-week and 1-month follow-up (P < 0.05). The good-to-excellent rates of the PBDS group and VRS group were 90.97% and 81.14%, whereas the complication occurrence rates were 11.80% and 15.30% in the PBDS group and VRS group, respectively. PBDS and VRS have acceptable efficacy at a midterm follow-up of 2 years in treating LDH with PTED. Although PBDS is associated with longer intraoperative fluoroscopy and operative times, it should still be considered superior to VRS considering the benefits of fewer complications, quicker pain relief, and functional recovery.