Percutaneous endoscopic suprapedicular decompression in the treatment of down-migrated lumbar disc herniation.

[OBJECTIVE]: This study aimed to investigate the clinical efficacy of percutaneous endoscopic suprapedicular decompression in treatment of down-migrated lumbar disc herniation. [METHODS]: The clinical data of 43 patients with down-migrated lumbar disc herniation treated with endoscopic surgery at our hospital between January 2022 and January 2023 were retrospectively analysed. Twenty-two and 21 patients underwent percutaneous endoscopic decompression using the suprapedicular and TESSYS approaches, respectively. The perioperative, follow-up, and imaging data of the groups were compared. [RESULTS]: Surgery was uneventful in both groups. The number of intraoperative fluoroscopies and duration of surgery were significantly lower in the suprapedicular group (p<0.05). The patients in both groups were followed up for at least 12 months. At the last follow-up, lumbar pain and leg pain visual analogue scale (VAS), Oswestry Disability Index (ODI), and 36-Item Short Form Health Survey (SF-36) scores were significantly improved in both groups compared with preoperative values (p<0.05); the differences in these indexes between the two groups were not significant preoperatively (p>0.05). However, at the last postoperative follow-up, lumbar pain VAS scores were significantly better in the suprapedicular group (0.83±0.85 vs. 2.54±1.32, p<0.05). There was no significant change in intervertebral space height or lumbar lordotic angle compared with preoperative values in either group at the last follow-up (p>0.05). However, the spinal canal cross-sectional area significantly increased (p<0.05). [CONCLUSION]: The treatment of down-migrated lumbar disc herniation via a suprapedicular approach enabled the incision of the superior margin of the pedicle as needed under direct vision, involved less fluoroscopy while preserving facet joint stability, and enabled targeted removal of the herniated nucleus pulposus, thus greatly reducing residual nucleus pulposus. This surgical procedure was safe, rapid, and showed satisfactory therapeutic efficacy.