• Imran Khan Department of Neurosurgery, Hayatabad Medical Complex, Peshawar
  • Sohail Amir Department of Neurosurgery, Hayatabad Medical Complex, Peshawar
  • Atif Amman Department of Neurosurgery, Hayatabad Medical Complex, Peshawar
  • Hanif-ur- Rehman Department of Neurosurgery, Hayatabad Medical Complex, Peshawar
  • Ayaz Afridi Department of Neurosurgery, Hayatabad Medical Complex, Peshawar
  • Muhammad Ali Numan Department of Neurosurgery, Hayatabad Medical Complex, Peshawar
  • Shahid Ayub Department of Neurosurgery, Hayatabad Medical Complex, Peshawar
Keywords: spine, orthopedics, endoscopic discectomy, lumbar disc prolapse, disc degenerative disease.


Introduction: Chronic lumbosacral pain is a communal and difficult clinical condition at the center of pain management. The most common surgical indication is back pain or intractable and severe functional impairment that does not respond to conservative measures. In this study we have compared the results of endoscopic d microdiscectomy and conventional discectomy procedure.

Material and Methods: We included 54 patients with severe lower back pain who did not improve after long-term conservative treatment and who had level 3 disc prolapse, radiating to one or both lower limbs. Oswestry Disability Index (For Low Back Pain) was documented with questionnaire comeback and applied as a clinical tool for valuation.

Results: The average age of the 54 patients was 46 years and 75% of patients have paracentral disc protrusion. The mean endoscopic microdiscectomy surgery time was 110 minutes; was longer than conventional discectomy (82 minutes). However, blood loss was very small compared to conventional discectomy. According to the ODI result, both conventional and endoscopic discectomy gave same outcomes in all classes.

Conclusion: Endoscopic microdiscectomy is a new, effective and safe procedure that reduces the invasiveness of the surgical approach. The results obtained by this approach are comparable with those obtained with open discectomy to alleviate symptoms during prolonged observation, and because the tissue has minimal trauma, it is much better in early mobilization and morbidity.


1. Wei, Feilong, Haoran Gao, Yifang Yuan, Shu Qian, Quanyou Guo, Shikong Guo, Weigao Xue, Chengpei Zhou, and Jixian Qian. "Comparison of Outcomes Postoperation between Straight Leg Raising Test Negative and Positive Patients Who Underwent Percutaneous Transforaminal Endoscopic Discectomy for Lumbar Disc Herniation."
2. Liu, Xinyu, Suomao Yuan, Yonghao Tian, Lianlei Wang, Liangtai Gong, Yanping Zheng, and Jianmin Li. "Comparison of percutaneous endoscopic transforaminal discectomy, microendoscopic discectomy, and microdiscectomy for symptomatic lumbar disc herniation: minimum 2-year follow-up results." Journal of Neurosurgery: Spine 28, no. 3 (2018): 317-325.
3. Kim, Seung-Kook, Sang-Soo Kang, Young-Ho Hong, Seung-Woo Park, and Su-Chan Lee. "Clinical comparison of unilateral biportal endoscopic technique versus open microdiscectomy for single-level lumbar discectomy: a multicenter, retrospective analysis." Journal of orthopaedic surgery and research 13, no. 1 (2018): 22.
4. Kim, Manyoung, Sol Lee, Hyeun-Sung Kim, Sangyoon Park, Sang-Yeup Shim, and Dong-Ju Lim. "A comparison of percutaneous endoscopic lumbar discectomy and open lumbar microdiscectomy for lumbar disc herniation in the Korean: a meta-analysis." BioMed research international 2018 (2018).
5. Choi, Kyung-Chul, Hyeong-Ki Shim, Jin-Sup Hwang, Seung Ho Shin, Dong Chan Lee, Hwan Hui Jung, Hyeon Ah Park, and Choon-Keun Park. "Comparison of surgical invasiveness between microdiscectomy and 3 different endoscopic discectomy techniques for lumbar disc herniation." World neurosurgery 116 (2018): e750-e758.
6. Ahn, Yong, Sang Gu Lee, Seong Son, and Han Joong Keum. "Transforaminal endoscopic lumbar discectomy versus open lumbar microdiscectomy: a comparative cohort study with a 5-year follow-up." Pain physician 22, no. 3 (2019): 295-304.
7. Marappan, Kodeeswaran, Ranganathan Jothi, and Sherina Paul Raj. "Microendoscopic discectomy (MED) for lumbar disc herniation: comparison of learning curve of the surgery and outcome with other established case studies." Journal of Spine Surgery 4, no. 3 (2018): 630.
8. Alvi, Mohammed Ali, Panagiotis Kerezoudis, Waseem Wahood, Anshit Goyal, and Mohamad Bydon. "Operative approaches for lumbar disc herniation: a systematic review and multiple treatment meta-analysis of conventional and minimally invasive surgeries." World neurosurgery 114 (2018): 391-407.
9. Qin, Rongqing, Baoshan Liu, Jie Hao, Pin Zhou, Yu Yao, Feng Zhang, and Xiaoqing Chen. "Percutaneous endoscopic lumbar discectomy versus posterior open lumbar microdiscectomy for the treatment of symptomatic lumbar disc herniation: a systemic review and meta-analysis." World neurosurgery 120 (2018): 352-362.
10. Kosztowski, Thomas A., David Choi, Jared Fridley, Michael Galgano, Ziya Gokaslan, Adetokunbo Oyelese, and Albert Edward Telfeian. "Lumbar disc reherniation after transforaminal lumbar endoscopic discectomy." Annals of translational medicine 6, no. 6 (2018).
11. Choi, Kyung-Chul, Hyeong-Ki Shim, Jin-Sung Kim, Kyung Han Cha, Dong Chan Lee, Ea Ran Kim, Mee Jung Kim, and Choon-Keun Park. "Cost-effectiveness of microdiscectomy versus endoscopic discectomy for lumbar disc herniation." The Spine Journal 19, no. 7 (2019): 1162-1169.
12. Vora, Padmanabh, Parth Thaker, Jeet Gandhi, Yash Gupta, Himanshu Panchal, and Mukund Prabhakar. "Comparing results of Endoscopic microdiscectomy and conventional discectomy for lumbar disc disease: A short term study." International Journal of Orthopaedics 5, no. 1 (2019): 30-33.
13. Sah, Raj Kumar, Tao Li, Zhiyue Shi, Jingming Xie, and Yingsong Wang. "Clinical outcome of percutaneous endoscopic lumbar discectomy and open lumbar microdiscectomy for lumbar disc herniation: A literature review." (2019).
14. Kapetanakis, Stylianos, Nikolaos Gkantsinikoudis, Constantinos Chaniotakis, Georgios Charitoudis, and Panagiotis Givissis. "Percutaneous transforaminal endoscopic discectomy for the treatment of lumbar disc herniation in obese patients: health-related quality of life assessment in a 2-year follow-up." World neurosurgery 113 (2018): e638-e649.
15. MEYER, GUILHERME, IVAN DIAS DA ROCHA, ALEXANDRE FOGAÇA CRISTANTE, RAPHAEL MARTUS MARCON, THIAGO PEREIRA COUTINHO, ALESSANDRO GONZALEZ TORELLI, PEDRO ARAUJO PETERSEN, OLAVO BIRAGHI LETAIF, and TARCÍSIO ELOY PESSOA DE BARROS FILHO. "Percutaneous Endoscopic Lumbar Discectomy Versus Microdiscectomy for the Treatment of Lumbar Disc Herniation: Pain, Disability, and Complication Rate—A Randomized Clinical Trial." International Journal of Spine Surgery 14, no. 1 (2020): 72-78.
Original Article