Comparison of Clinical Outcomes and Biochemical Markers Following Tubular Microscopic Discectomy Versus Full Endoscopic Discectomy for Lumbar Disc Herniation: A Prospective Randomized Controlled Trial.

Abstract

Study DesignProspective randomized controlled trial.ObjectiveTo compare clinical outcomes and biochemical markers in patients undergoing tubular microscopic discectomy (TMD) versus full endoscopic discectomy (FED).MethodsThis prospective randomized controlled trial was conducted at a tertiary spine center between February 2022 and December 2023. A total of 209 patients with symptomatic lumbar disc herniation were randomized using a sealed opaque envelope allocation method to undergo either FED or TMD. For subgroup analysis, FED cases were stratified into interlaminar (IL-FED) and transforaminal (TF-FED) approaches. Clinical outcomes were systematically evaluated using the Visual Analog Scale (VAS), Oswestry Disability Index (ODI) and modified MacNab criteria preoperatively, immediately postoperatively, and at 3-, 6- and 12-month follow-up intervals. Biochemical markers, including C-reactive protein (CRP) and creatine phosphokinase-MM (CPK-MM) were measured preoperatively and at 24 hours postoperatively to assess muscle injury and inflammatory response. Secondary outcomes included perioperative complications and time to return to work.ResultsBoth groups demonstrated statistically significant improvement in VAS and ODI scores across all follow-up intervals. Although baseline VAS differed statistically between groups, the magnitude of this difference was not clinically meaningful and did not influence postoperative outcomes. The FED group demonstrated significantly better ODI and MacNab scores, reflecting improved functional recovery and patient satisfaction. Postoperative CRP and CPK-MM levels were significantly lower in the FED group, indicating reduced paraspinal muscle injury and systemic inflammatory response.ConclusionBoth TMD and FED are effective treatment modalities. However, FED is associated with reduced muscle injury and accelerated postoperative recovery.