Collagenase chemonucleolysis versus percutaneous endoscopic discectomy for extraforaminal lumbar disc herniations

Objective: To compare the advantages and disadvantages of collagenase chemonucleolysis and percutaneous endoscopic discectomy (PED) in the management of extraforaminal lumbar disc herniation. Methods: In this non-randomized controlled clinical trial, a total of 49 patients who were diagnosed with extraforaminal lumbar disc herniation were assigned to undergo either PED (n=22) or collagenase chemonucleolysis (n=27). The primary outcomes were pain improvements (VAS scores), therapeutic efficacy (improved MacNab criteria) and the incidence of complications within 6 months after operation; and the secondary outcomes included intraoperative pain symptoms, operation duration, the time for postoperative bed rest and the costs for hospitalization. Results: The preoperative basic information was similar among the patients in both groups (P>0.05). Besides, no significant differences in postoperative Visual Analogue Scale (VAS) score at two weeks, three months, and six months, as well as in the postoperative therapeutic efficacy at six months respectively were found between both groups (P>0.05). Neither groups had severe complications (P>0.05). The patients with collagenase chemonucleolysis had longer bed rest duration, but fewer costs for hospitalization, shorter operation time, less intraoperative pain compared with the PED patients (P<0.001). Conclusion: Collagenase chemonucleolysis is safe and effective for extraforaminal lumbar disc herniations, and has the advantages of immediate relief of intraoperative pain, reduced costs for hospitalization, and simpler operation.