Percutaneous Endoscopic Lumbar Discectomy Serves as a Valuable Minimally Invasive Surgical Option for Adolescent Lumbar Disc Herniation: Mid-Term Outcomes from a Retrospective Cohort Study

Objective: To compare perioperative outcomes, mid-term clinical efficacy, and sciatic scoliosis correction after percutaneous endoscopic lumbar discectomy (PELD) versus mini-open fenestration discectomy (MOFD) for adolescent lumbar disc herniation (ALDH). Methods: This retrospective cohort study reviewed 174 patients aged ≤ 21 years who underwent single-level L4/5 or L5/S1 discectomy between January 2021 and December 2024. Patients were grouped by procedure: PELD (n=83; TELD 44, IELD 39) or MOFD (n=91). Perioperative outcomes, VAS, ODI, EQ-5D, modified MacNab results, complications, recurrence, and radiographic correction of sciatic scoliosis were compared. Results: Baseline characteristics were comparable between groups. Compared with MOFD, PELD had a smaller incision (0.9± 0.3 vs 3.7± 0.7 cm; p< 0.001), lower blood loss (13.6± 12.1 vs 48.2± 51.5 mL; p< 0.001), no postoperative drainage, and shorter postoperative hospital stay (2.7± 1.0 vs 4.5± 1.6 days; all P< 0.001). Operative time did not differ significantly. Both groups showed sustained improvement in VAS, ODI, and EQ-5D. The only between-group clinical difference was lower VAS back pain on postoperative day 1 after PELD, which did not persist. Excellent/good MacNab outcomes were similar (94.0% vs 94.5%). Same-level recurrence occurred in 3.6% and 2.2%, respectively. Among 63 patients with sciatic scoliosis, both procedures achieved comparable Cobb angle and AVT correction, with satisfactory radiographic and clinical correction in 95.2%. Conclusion: In this retrospective cohort, PELD provided less surgical trauma and faster early recovery than MOFD while achieving comparable mid-term functional outcomes and sciatic scoliosis correction. These findings support PELD as a valuable minimally invasive option for ALDH patients.