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Updated: Aug 5, 2026
Full Endoscopic Interlaminar Approach for Paracentral L5-S1 Disc Herniation
Published on: April 14, 2023
Percutaneous Endoscopic Interlaminar Discectomy via a Modified Inferolateral Margin of the L5 Pedicle Projection for
Chenxing Huang1, Bin Xie1, Zhuangzhuang Tan1
1Department of Spine Surgery, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou 510260, China.
Abstract:
Objective: To evaluate the feasibility and short-term outcomes of a modified percutaneous endoscopic interlaminar discectomy (PEID) trajectory via the inferolateral margin of the L5 pedicle projection for central disc herniation at L5/S1. Methods: From June 2023 to July 2025, a consecutive cohort of 70 patients diagnosed with L5/S1 lumbar disc herniation (LDH) undergoing modified projection PEID was enrolled. Based on preoperative MRI (magnetic resonance imaging) evaluation of herniation types, they were divided into a central herniation group (n = 32) and a non-central herniation group (n = 38). Clinical outcomes and radiographic parameters were subsequently compared between the groups. Results: Seventy patients were included (38 non-central and 32 central). Baseline characteristics were comparable between the two groups except for a higher prevalence of bilateral symptoms in the central herniation group (p = 0.036). The central herniation group exhibited significantly shorter operative time (p = 0.027), reduced intraoperative blood loss (p = 0.047), and lower haemoglobin drop (p = 0.033). Multivariable linear regression confirmed that central herniation was independently associated with improved surgical efficiency. Both groups demonstrated significant postoperative improvements in VAS (Visual Analogue Scale) and JOA (Japanese Orthopaedic Association) scores. Although the non-central herniation group showed a higher JOA score on postoperative day 1 (p = 0.047), no significant differences were observed at 3 months or the final follow-up. The modified MacNab satisfaction rates were comparable (p = 0.411), with a similarly low complication rate in both groups. Conclusions: The modified PEID trajectory via the inferolateral margin of the L5 pedicle projection is feasible for central L5/S1 disc herniation and is associated with reduced operative time and decreased intraoperative blood loss.
Insights
A modified endoscopic spine surgery approach is effective for central L5/S1 disc herniation. This technique reduces surgery time and blood loss while achieving comparable patient satisfaction and outcomes.
Area of Science:
- Neurosurgery
- Orthopedic Surgery
- Minimally Invasive Spine Surgery
Background:
- Lumbar disc herniation (LDH) at L5/S1 is a common cause of low back pain.
- Percutaneous endoscopic interlaminar discectomy (PEID) is a minimally invasive technique for LDH.
- A modified PEID trajectory may offer advantages for central herniations.
Purpose of the Study:
- To assess the feasibility and short-term outcomes of a modified PEID trajectory.
- To evaluate this technique specifically for central L5/S1 disc herniation.
- To compare outcomes between central and non-central herniation groups.
Main Methods:
- A cohort of 70 patients with L5/S1 LDH underwent modified PEID.
- Patients were categorized into central (n=32) and non-central (n=38) herniation groups based on MRI.
- Clinical outcomes (VAS, JOA scores) and surgical parameters were compared.
Main Results:
- The central herniation group had shorter operative times, less blood loss, and lower hemoglobin drop.
- Central herniation was independently linked to improved surgical efficiency.
- Both groups showed significant pain reduction and functional improvement, with comparable long-term satisfaction.
Conclusions:
- The modified PEID trajectory is feasible for central L5/S1 disc herniation.
- This approach offers benefits in terms of surgical efficiency and reduced intraoperative complications.
- Short-term outcomes and patient satisfaction are comparable to non-central herniations.
