Comparison of Two Different Foraminoplasty Methods in Full Endoscopic Lumbar Discectomy

Retrospective cohort study.

To compare the advantages and disadvantages of two different foraminoplasty methods.

Foraminoplasty is one of the most important steps in FELD surgery. In recent years, different surgical instruments for foraminoplasty have been invented, mainly, including reamer/trephine and bone drill. Different foraminoplasty methods have different effects and limitations on the surgical outcome.The aim of this study was to compare surgical outcomes, anesthesia satisfaction, and learning curves between two different foraminoplasty procedures.

A total of 109 patients with lumbar disc herniation (LDH) treated with full endoscopic lumbar discectomy (FELD) by the same group of physicians from October 2020 to February 2022. Patients underwent foraminoplasty with bone drill were divided into group A, while foraminoplasty with trephine as group B. Back and leg visual analogue scale (VAS), Oswestry disability index (ODI) were evaluated at different time follow-up for evaluating surgical outcomes. Different types of anesthesia were recorded, and patients' intraoperative pain assessment was evaluated. Learning curve was presented with operation time in chronological order.

There were statistically differences between VAS-back postoperative (P=0.0077) on 6 months. There was also a statistical difference in back pain symptom scores under the interaction between groups and time (P=0.147). The intraoperative VAS score of group A was significantly higher group B (P=0.008). Migration herniated discs and foraminoplasty method were the main factors affecting intraoperative pain. The operation time of group A was shorter than that of group B, while there was no statistical difference (P=0.782).

Both surgical techniques can achieve good curative effect (excellent rate: 87.7% vs. 89.1%). Patients in group A recovered faster on postoperative function. Patients in group B had better intraoperative experience.