Effect of transforaminal endoscopic discectomy extent on postoperative neurological recovery in lumbar disc herniation: a retrospective cohort study

To investigate whether limited discectomy versus aggressive disc removal influences postoperative neurological recovery in lumbar disc herniation patients undergoing transforaminal endoscopic discectomy.

This retrospective cohort study analyzed 288 patients undergoing percutaneous endoscopic lumbar discectomy (PELD) at our institution between January 2022 and January 2025. Patients were stratified by surgical approach based on established criteria: Aggressive Discectomy Group (comprehensive removal of herniated disc and extensive nucleus pulposus extraction, n = 135) versus Limited Discectomy Group (selective neural decompression preserving disc architecture, n = 153). Primary outcome was neurological recovery at 6 months, assessed via MRC motor grading and sensory function testing. Secondary outcomes included visual analog scale (VAS) pain scores, Oswestry disability index (ODI), operative duration, and complications.

Both groups demonstrated significant improvement in neurological function from baseline to 6 months postoperatively. No significant differences emerged between groups regarding sensory function recovery (normal/reduced sensation at 6 months: 126/9 vs. 149/4, χ ² = 2.732, p = 0.098) or motor strength recovery. Mean VAS scores declined from 5.41 ± 1.06 to 0.40 ± 0.55 (Aggressive group) and from 5.39 ± 1.23 to 0.53 ± 0.61 (Limited group) with no significant between-group differences (p > 0.05). ODI scores improved from 61.96 ± 8.52 to 23.21 ± 4.53 (Aggressive group) and from 63.62 ± 7.96 to 22.63 ± 4.82 (Limited group, p > 0.05). However, operative duration was significantly shorter in the Limited Discectomy Group (100.41 ± 32.33 vs. 108.48 ± 31.61 min, p = 0.034). No infections, hematomas, nerve root injuries, or recurrences occurred in either group during follow-up.

Limited discectomy achieved equivalent neurological recovery outcomes compared to aggressive disc removal while requiring significantly less operative time. These findings support adopting less extensive surgical approaches when adequate neural decompression can be accomplished, potentially reducing surgical trauma while maintaining therapeutic efficacy. While these 6-month findings support limited discectomy for early recovery, longer follow-up studies are needed to assess medium to long-term outcomes including recurrence rates and degenerative changes.