Pre-operative collapsed disc is a negative prognostic factor of back-pain outcome in trans-foraminal endoscopic discectomy. A single cohort clinical study

Purpose

Trans-foraminal endoscopic discectomy (TELD) is an alternative surgical technique for lumbar disc herniation (LDH). Compared with microscope-assisted open discectomy, TELD is expected to result in less postoperative low back pain (LBP) and has a lower likelihood of complications. However, some clinical analysis report patients still had persistent LBP at follow-up. Several studies have identified different known risk factors for LBP after TELD, including the preoperative presence of disc height loss and “microinstability” of the lumbar spine, which can be detrimental to a patient's successful outcome.

Methods

We conducted a retrospective review of a cohort of 86 patients with symptomatic LDH who underwent TELD surgery in a single Neurosurgery Unit from 2021 to 2023 and subjected themselves to a clinical and radiological follow-up program up to one year, focusing on the presence of collapsed disc (Group A) and the presence of normal intersomatic height (Group B) at the site of lumbar herniation.

Results

The two groups demonstrated no significant differences in the pain and disability scales at the preoperative and postoperative phases, both after surgery and during follow-up. However, at the 1-year clinical evaluation, patients who had signs of a collapsed disc before surgery experienced less recovery on the ODI scale compared to the other group

Conclusion

Our study showed that the presence of severe intervertebral disc height loss, accompanied by pre-operative signs of a collapsed disc at the site of the LDH, may serve as a predictor of poor postoperative pain recovery.