Comparison of the Converging Decompression Technique and Foraminoplasty Percutaneous Transforaminal Endoscopic Discectomy in the Treatment of Very Highly Upward Migrated Lumbar Disc Herniation.

Abstract

This study aims to describe converging decompression technique (CDT) procedure in detail and assess its clinical efficacy in comparison with foraminoplasty percutaneous transforaminal endoscopic discectomy (PTED) for the management of very highly up-migrated lumbar disc herniation (VHUM-LDH). A retrospective study was performed on 66 patients diagnosed with VHUM-LDH who underwent surgery between January 2020 and January 2024. Of these, 27 patients were treated with CDT (CDT group), and 39 with foraminoplasty PTED (PTED group). Clinical parameters, including Oswestry Disability Index, visual analog scale scores for back and leg pain, and modified MacNab criteria were analyzed. Both groups demonstrated significant postoperative improvements in leg and back pain visual analog scale scores and Oswestry Disability Index scores. No significant differences were observed between the groups at any follow-up time point (P>0.05). The PTED group required fewer fluoroscopic exposure times (10.82±2.47 vs. 18.74±3.66, P<0.05) compared to the CDT group. However, the CDT group had a shorter endoscopic procedure duration (46.96±4.17 vs. 59.77±8.31 min, P<0.05). There were no significant differences between the groups regarding complication rates or good-to-excellent outcomes as per the modified MacNab criteria (P>0.05). Both CDT and foraminoplasty PTED are safe and effective treatments for VHUM-LDH. However, CDT offers enhanced endoscopic efficiency and a reduced risk of postoperative nucleus pulposus remnants. Further prospective studies with larger cohorts and extended follow-up are required to fully assess the advantages and limitations of both techniques.