Abstract：Objective To evaluate the clinical applicability of percutaneous transforaminal endoscopic discectomy (PTED) by comparing imaging diagnosis improvements before and after respective treatment with PTED and with discectomy in patients with lumbar intervertebral disc protrusion. Methods Sixty patients with L4/5 disc protrusion treated between July 2017 and December 2018 were randomly divided into two groups: PTED group and discectomy group, with 30 cases in each. Imaging data collected one day before operation, one day after operation, three months after operation, six months after operation and one year after operation was analyzed. Results On the X-ray film, the lumbar lordosis angle and the sacral inclination angle of patients in both groups began to increase one day after operation, P<0.05, but there was no significant difference between the two groups. There was no significant change in the lumbosacral angle postoperatively.No significant difference was seen in the intervertebral space (L3-4) height one day after operation. However, three months after operation, the height decreased gradually, suggesting that degeneration had occurred in patients in the discectomy group (P<0.05),but there were no obvious changes in the PTED group. At the same time point, there was no significant difference in the lumbar lordosis angle or sacral inclination angle between the two groups, but the L3-4 intervertebral space height of the PTED group was significantly higher, P<0.05. On the magnetic resonance imaging, the relative signal intensity (RSI) of either group did not change significantly one day and three months after operation. The RSI hardly changed in the PTED group six months and one year after operation, but it significantly decreased in the discectomy group six months after operation and trended down, P<0.05. There was no significant difference in the RSI between the two groups before operation, one day and three months after operation, but six months and one year after operation, the RSI in the PTED group increased more significantly than in the discectomy group (P<0.05). Six months after operation, gradual degeneration occurred in the adjacent L3-4 segments of the disc in the discectomy group. Conclusions PTED is an efficient and safe approach to lumbar intervertebral disc protrusion. PTED has advantages over discectomy in the anatomical structure of the adjacent intervertebral disc, pathological changes and in the incidence of degeneration.
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