Percutaneous endoscopic lumbar discectomy combined with annular suture versus PELD alone for single-level lumbar disc herniation: A prospective propensity score-matched cohort study.

Abstract

BackgroundSymptomatic same-level recurrence remains a concern after percutaneous endoscopic lumbar discectomy (PELD). We compared PELD plus endoscopic annular suture with PELD alone.MethodsThis single-center prospective observational cohort enrolled patients from January 2023 through October 2024. Treatment was selected through shared clinician-patient decision-making. Propensity scores based on eight baseline variables were matched 1:1, yielding 51 patients per group. Clinical scores were assessed through 12 months; symptomatic recurrence was followed for up to 23.9 months. Kaplan-Meier and exploratory Cox analyses were used.ResultsBoth groups improved. At 6 and 12 months, the suture group had better Japanese Orthopaedic Association and Oswestry Disability Index scores, whereas 12-month pain scores were similar. Symptomatic recurrence occurred in 13/51 controls (25.49%) and 4/51 suture patients (7.84%; P = 0.017). Eighteen-month recurrence-free estimates were 75.2% (95% CI 59.2%-85.6%) and 94.9% (95% CI 80.3%-98.7%), respectively (log-rank P = 0.028). Reoperation (10/51 vs 4/51; P = 0.084) and complications (4/51 vs 3/51) did not differ significantly. Subgroup estimates were limited by only 17 events.ConclusionsAnnular suture was associated with better short-to midterm function and fewer symptomatic recurrences, but causality and long-term effectiveness remain uncertain. Larger multicenter studies with longer, imaging-based follow-up are required.