How reliable is percutaneous transforaminal endoscopic discectomy during the learning curve? A comparison of outcomes with microsurgical discectomy experiences

Abstract

We aimed to share our early experience with percutaneous transforaminal endoscopic discectomy (PTED) during the initial phase of the learning curve and to compare its clinical and perioperative outcomes with microsurgical discectomy (MD) in selected patients with symptomatic lumbar disc herniation (LDH). In this retrospective study, patients who underwent PTED or MD for symptomatic LDH since 2019 and completed at least 6 months of postoperative follow-up were analyzed. Patients with acute paresis, cauda equina syndrome, significant concomitant spinal stenosis, calcified disc herniation, high-positioned iliac crest preventing safe transforaminal access, markedly migrated disc fragments, or a need for multilevel surgery were excluded from the comparative cohort. VAS and ODI scores, operative duration, transfusion requirement, length of stay, complications, follow-up, and reoperation rates were evaluated. A total of 185 patients (88 PTED and 97 MD) were included. Postoperative VAS scores and ODI changes were not significantly different between the groups, while both techniques produced significant postoperative pain improvement. Mean operative duration was similar between the groups. PTED was associated with a shorter hospital stay ( p < 0.001) and fewer perioperative complications ( p = 0.004). No patient in the PTED group required transfusion; however, this variable should be interpreted as transfusion requirement rather than measured blood loss. Reoperation was required in 11 patients (7 PTED and 4 MD), without a statistically significant difference between groups ( p = 0.125). In carefully selected patients with symptomatic lumbar disc herniation, PTED provided postoperative pain relief and functional outcomes comparable to MD, even during the early learning curve period. PTED was also associated with shorter hospital stay and fewer postoperative complications, while operative times were similar between groups. However, given the retrospective design and selected patient population, these findings should be confirmed by prospective studies with longer follow-up and quantitative learning curve analysis.