Abstract
BACKGROUND: Lumbar disc herniation (LDH), a common degenerative spinal issue, significantly impairs the quality of life. Percutaneous endoscopic lumbar discectomy (PELD) under local anesthesia is a groundbreaking minimally invasive approach for LDH, yet its effectiveness across diverse symptom severities remains underexplored. OBJECTIVES: This study aimed to evaluate the clinical efficacy, safety, patient satisfaction, and recurrence risk of PELD under local anesthesia in patients with LDH, stratified by symptom severity, to redefine treatment paradigms and optimize patient outcomes. METHODS: In a prospective, single-center observational cohort study, 100 patients with LDH were stratified into mild, moderate, and severe symptom groups and underwent PELD under standardized local anesthesia protocols. Outcomes were assessed over a 24-month follow-up, with primary endpoints including Visual Analog Scale (VAS) pain scores, Oswestry Disability Index (ODI), and Short Form-36 quality of life scores. Secondary endpoints encompassed perioperative metrics, complications, and recurrence rates, analyzed via Kaplan-Meier survival and Cox regression models. RESULTS: PELD yielded remarkable improvements across all severity groups, with VAS back pain reductions of 73.8% (mild), 70.5% (moderate), and 73.0% (severe), VAS leg pain reductions of 83.3%, 77.9%, and 76.9%, respectively, and ODI score improvements of 77.0%, 73.6%, and 72.6% (all p < 0.001). Complication rates were low at 8%, with no major adverse events. The 24-month recurrence-free survival rate was 91.0%, with severe symptoms (HR 1.78, p = 0.001) and diabetes mellitus (HR 1.60, p = 0.010) as key recurrence predictors. Patient satisfaction reached 89%, with higher satisfaction in milder cases. CONCLUSIONS: PELD under local anesthesia delivers exceptional clinical outcomes, safety, and patient satisfaction across the full spectrum of LDH severity, challenging conventional surgical limitations. These findings advocate for broader adoption of PELD, emphasizing tailored risk stratification to enhance long-term success and transform LDH management.