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Updated: Jun 2, 2026
Full-Endoscopic Transforaminal Approach for Lumbar Discectomy
Published on: September 8, 2023
Microendoscopic versus open discectomy for lumbar disc herniation: a prospective randomised study
Bhavuk Garg1, Upendra Bidre Nagraja, Arvind Jayaswal
1Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India.
Purpose:
To compare the outcomes of microendoscopic discectomy (MED) versus open discectomy for lumbar disc herniation.
Methods:
80 men and 32 women aged 26 to 57 (mean, 37) years with a single-level disc herniation were randomised to undergo MED (n=55) or open (fenestration/laminotomy) discectomy (n=57). Patients were assessed pre- and post-operatively (at week 6, month 6, and year one). The 2 groups were compared with respect to surgical time, anaesthesia time, duration of hospital stay, intra-operative blood loss, weight of disc material removed, and self-evaluated low back pain and functional outcome (using the Oswestry low back pain disability questionnaire).
Results:
Surgical and anaesthesia times were significantly longer, but blood loss and hospital stay were significantly reduced in patients having MED than open discectomy. The improvement in the Oswestry score in both groups was significant at week one, but not at other follow-ups. The complication rate was similar in both groups. One patient with MED had a recurrence of disc herniation after 7 months and was treated with open discectomy.
Conclusions:
Both methods are equally effective in relieving radicular pain. MED entailed shorter hospital stay, less morbidity, and earlier return to work. Nonetheless, it is a demanding technique and should not be attempted without specific instruction and training.
Insights
Microendoscopic discectomy (MED) and open discectomy offer similar pain relief for lumbar disc herniation. MED results in shorter hospital stays and less morbidity, but requires specialized training.
Area of Science:
- Neurosurgery
- Orthopedic Surgery
Background:
- Lumbar disc herniation is a common cause of low back pain and radiculopathy.
- Surgical interventions aim to decompress neural elements and restore function.
Purpose of the Study:
- To compare the clinical outcomes of microendoscopic discectomy (MED) and open discectomy for treating lumbar disc herniation.
- To evaluate differences in surgical parameters, patient recovery, and functional outcomes between the two techniques.
Main Methods:
- A randomized controlled trial involving 112 patients with single-level lumbar disc herniation.
- Patients were assigned to either MED or open discectomy (fenestration/laminotomy).
- Outcomes assessed included surgical time, anesthesia duration, hospital stay, blood loss, and Oswestry Low Back Pain Disability Index scores at multiple follow-up points.
Main Results:
- Microendoscopic discectomy (MED) was associated with significantly longer surgical and anesthesia times compared to open discectomy.
- MED patients experienced significantly reduced intra-operative blood loss and shorter hospital stays.
- Both techniques showed significant improvement in Oswestry scores at one week post-operatively, with no significant differences at later follow-ups. Complication rates were similar.
Conclusions:
- Both microendoscopic discectomy (MED) and open discectomy are effective for radicular pain relief in lumbar disc herniation.
- MED offers advantages such as reduced morbidity and earlier return to work, but necessitates specific training due to its technical demands.
