Impact of degenerative disc changes on the early outcomes in patients undergoing endoscopic lumbar discectomy - a prospective analysis

Abstract

Introduction Lumbar disc herniation (LDH) is a prevalent condition that can cause radiculopathy and leg pain. Full-endoscopic lumbar discectomy (FELD) has emerged as a minimally invasive alternative to microdiscectomy, offering similar clinical efficacy with potentially reduced recovery times. Degenerative disc disease (DDD) is frequently observed in patients undergoing surgery, yet its influence on surgical early outcomes of FELD remains unclear. Methods This prospective study included 91 patients who underwent FELD for single-level LDH between January 2022 to March 2024. Patients were classified in two groups based on Pfirrmann grade: grade inferior to 4 (Group 1) and grades 4 or 5 (Group 2). Clinical outcomes were assessed using the Numeric Rating Scale (NRS) for back and leg pain preoperatively and at 2, 14, 30, and 90 days postoperatively, and the Oswestry Disability Index (ODI) preoperatively and at 30and 90 days postoperatively. Results Among the 91 patients, 89% had advanced disc degeneration (Pfirrmann grades 4 or 5). Preoperatively, Group 1 (all Pfirrmann 3) had significantly higher back pain (NRS 8.2 vs. 5.2, p < 0.01), while Group 2 had a greater difference between leg and back pain (p = 0.041). Postoperatively, both groups experienced significant pain relief, but Group 1 showed superior back pain improvement across all time points. No significant differences were observed in ODI scores or leg pain improvement. Conclusion Patients with moderate disc degeneration (Pfirrmann grade 3) exhibited greater preoperative back pain but experienced superior back pain relief following FELD compared to those with advanced degeneration (Pfirrmann grades 4 or 5).