Comparison of effect and complication among three different spinal endoscopic procedures for L4-5 rostrally migrated lumbar disc herniations: a 2-year retrospective cohort study.

Endoscopic management of L4-5 rostrally migrated lumbar disc herniation (LDH) poses technical challenges. The aim of this study was to compare the clinical outcomes and safety profiles of percutaneous endoscopic transforaminal discectomy (PETD), percutaneous endoscopic interlaminar discectomy (PEID), and unilateral biportal endoscopic discectomy (UBED) for treating this condition. A retrospective analysis of 81 patients who underwent PETD (n = 19), PEID (n = 36), or UBED (n = 26) from April 2019 to October 2022 at a single center was conducted. Over a 24-month follow-up, clinical evaluations included the visual analog scale (VAS), Oswestry Disability Index (ODI), and Japanese Orthopaedic Association (JOA) scores, as well as the modified MacNab criteria. Surgical parameters, facet joint integrity, and paraspinal muscle loss were analyzed. All three groups demonstrated significant postoperative improvement in VAS (low back pain and leg pain), ODI, and JOA scores. The UBED group had higher VAS scores for incision pain compared with the other two groups. Within 1 week after the procedure, both the PEID and UBED groups had lower VAS scores for leg pain and higher JOA scores. Notably, the PEID group exhibited the lowest ODI at the 1-week follow-up. At the final follow-up, no significant differences were observed in VAS, ODI, and JOA scores among these groups. No significant differences were observed in modified MacNab evaluation, complication rates, recurrence rates, or the loss ratio of paraspinal muscles. However, PEID and PETD demonstrated advantages in operative time, total incision length, intraoperative blood loss, fluoroscopy injection time, duration of the postoperative hospital stay, total hospitalization expenditure, and serum C-reactive protein and creatine phosphokinase levels. PEID showed optimal performance in preserving the integrity of L4-5 facet joints. PETD, PEID, and UBED demonstrated comparable and satisfactory long-term efficacy in treating rostrally migrated L4-5 LDH over a 2-year follow-up period. PEID emerged as the preferred approach for early postoperative recovery, offering superior preservation of L4-5 facet joint integrity and reduced surgical invasiveness.