Minimally invasive vs. microscopic discectomy for adolescent lumbar disc herniation: a comparative study of clinical...

Adolescent lumbar disc herniation (ALDH) represents 0.6-6.8% of all lumbar disc herniation cases, yet comparative studies of surgical techniques in this population remain limited. This study compared clinical and radiographic outcomes of three surgical approaches for ALDH.

A retrospective cohort study was performed by reviewing medical records of 150 adolescents with single-level L4-L5 lumbar disc herniation who received surgical treatment between January 2021 and July 2023. Patients were divided into three groups according to the surgical technique performed: microscopic fenestration discectomy (FD, n = 50), percutaneous endoscopic lumbar discectomy (PELD, n = 50), or unilateral biportal endoscopic discectomy (UBE, n = 50). The surgical approach was determined by the attending surgeon based on patient characteristics, herniation type, and surgeon expertise. Outcome measures included Visual Analog Scale (VAS) scores for back and leg pain, Japanese Orthopaedic Association (JOA) scores, Oswestry Disability Index (ODI), and spinopelvic parameters. Clinical assessments were performed preoperatively and at multiple postoperative intervals with mean follow-up of 33.5 months.

All groups demonstrated significant improvement in pain and functional outcomes. PELD showed superior perioperative advantages with shorter hospital stay (5.10 ± 0.42 vs. 7.68 ± 2.30 vs. 7.80 ± 1.36 days, p < 0.01) and operative time (81.36 ± 20.35 vs. 113.36 ± 14.86 vs. 118.26 ± 12.68 min, p < 0.01). UBE demonstrated lowest blood loss (228.64 ± 47.77 ml, p < 0.01). Early postoperative differences in VAS, JOA, and ODI scores converged by 6-month follow-up. Spinopelvic parameters showed significant improvements in pelvic tilt and sacral slope following minimally invasive procedures.

All three techniques provide effective symptom relief for ALDH. PELD offers rapid recovery advantages, while UBE minimizes surgical trauma. FD provides technical simplicity but may compromise long-term spinal biomechanics. Technique selection should consider individual patient factors and surgeon expertise.