Comparison of Radiological and Clinical Outcomes Between Aggressive and Limited Discectomy During Transforaminal Percutaneous Endoscopic Lumbar Discectomy: A Propensity Score-Matched Study

AIM: To compare the clinical, functional, and radiological outcomes of two nucleus pulposus management strategies, limited discectomy and aggressive discectomy, during percutaneous endoscopic lumbar discectomy (PELD), and to investigate the association between the extent of disc removal, postoperative Modic changes, and functional recovery.METHODS: A total of 200 patients with lumbar disc herniation who underwent transforaminal PELD between January 2023 and January 2025 were retrospectively enrolled. Patients were classified into an aggressive discectomy group (n = 88) and a limited discectomy group (n = 112) according to the intraoperative nucleus pulposus removal strategy. Propensity score matching (PSM) at a 1:1 ratio was performed to balance baseline characteristics between the two groups, resulting in 72 matched pairs for analysis. The primary outcome was the incidence of Modic changes at 1 year postoperatively. Secondary outcomes included recurrence, reoperation, complications, modified MacNab outcomes, and recovery of neurological function, pain, lumbar function, and quality of life.RESULTS: A total of 144 patients were included after PSM. Compared with the limited discectomy group, the aggressive discectomy group exhibited a significantly higher incidence of Modic changes at 1 year postoperatively (37.50% vs. 22.22%, p = 0.045). No significant differences were observed between the two groups in the 1-year recurrence rate, reoperation rate, complication rate, or the proportion of patients achieving excellent or good modified MacNab outcomes (all p > 0.05). At 1 month postoperatively, the aggressive discectomy group had higher low-back pain visual analogue scale (VAS) and Oswestry Disability Index (ODI) scores than the limited discectomy group (Holm-adjusted p = 0.012 and p < 0.001, respectively), whereas no significant between-group differences were observed at 6 or 12 months (all Holm-adjusted p > 0.05). Repeated-measures analysis showed significant group-by-time interactions for low-back pain VAS and ODI scores (pinteraction = 0.036 and 0.004, respectively), whereas the trajectories of the other functional outcomes were comparable between the groups (all pinteraction > 0.05).CONCLUSIONS: Among patients undergoing PELD for lumbar disc herniation, aggressive discectomy was associated with a higher incidence of Modic changes at 12 months, whereas no significant between-group difference in recurrence was observed. The association between aggressive discectomy and long-term recurrence requires further investigation.