Comparative Analysis of Percutaneous Full Endoscopic Lumbar Discectomy and Microdiscectomy in Terms of Preservation of Paraspinal Muscle Mass: A Retrospective Analysis

Abstract

Aim: This study aimed to compare percutaneous full endoscopic lumbar discectomy and microdiscectomy in terms of preservation of paraspinal muscle mass.

Materials and Methods: This retrospective observational analysis was conducted at Farooq Neurospine Institute. The patient records were analyzed from 2020 to 2022, with a 1-year follow-up period. Adults aged 18-65 years diagnosed with lumbar disc herniation based on clinical and radiological findings and treated with either PEED or MD were included. Preoperative and postoperative CT and/or MRI scans were evaluated to measure the cross-sectional area (CSA) of paraspinal and iliopsoas muscles at affected and adjacent levels.

Results: Of the 480 patients analyzed, 247 underwent PFED, and 233 received MD. The PFED group outperformed the MD group in terms of improvements in muscle cross-sectional area at the one-year follow-up. In PFED, the right and left psoas muscles grew by 94.21 ± 45.0 and 59.28 ± 50.0 mm², but in MD, they decreased by 24.28 ± 50.0 and 41.51 ± 55.0 mm² (p = 0.020 and 0.151). PFED showed better muscle preservation, with paraspinal muscles increasing by 133.84 ± 70.0 and 126.97 ± 68.0 mm² compared to losses of 144.88 ± 75.0 and 112.74 ± 72.0 mm² in MD (p < 0.001).

Conclusion: Radiological findings confirmed the superior muscle-preserving capacity of PFED compared to MD. Enhanced multifidus muscle strength and smaller reoperation incisions further demonstrated its minimally invasive benefits, contributing to reduced postoperative pain, faster recovery, and improved cosmetic outcomes