Percutaneous Transforaminal Endoscopic Discectomy Under Low-Dose Analgesic Spinal Anesthesia: Clinical and Functional Outcomes of a Single-Center Case Series
Abstract
Francesco Saturno, Giulia Monaco, Angela Salerno, Antonio Cianciola, Nicole Cianciola and Emidio Cianciola
Background: Percutaneous Transforaminal Endoscopic Discectomy (PTED) has become an established minimally invasive procedure for the treatment of lumbar disc herniation. The possibility of performing the procedure under low- dose analgesic spinal anesthesia while preserving patient cooperation may further improve procedural safety through continuous neurological monitoring.
Objective: To evaluate the feasibility, safety, and medium-term clinical outcomes of PTED performed under low-dose spinal analgesia in a consecutive single-center series.
Methods: A retrospective observational study was conducted on 60 consecutive patients treated between January 2022 and December 2024. Demographic characteristics, operative variables, complications, recurrence rate, pain intensity (VAS), functional disability (ODI), modified MacNab classification, and patient satisfaction were assessed over a 24-month follow-up.
Results: The mean age was 45 ± 11 years, 70% of patients were male, and the mean BMI was 28 ± 3.4 kg/m2. Mean operative time was 59 ± 14 minutes, while average hospital stay was 3.1 ± 0.8 days. Mean VAS improved from 8.2 ± 0.9 preoperatively to 2.1 ± 1.2 at 24 months (p < 0.001). Mean ODI decreased from 56 ± 11% to 21 ± 8% (p < 0.001). According to the modified MacNab criteria, 86.7% of patients achieved excellent or good outcomes. Minor complications occurred in 11.7% of patients and resolved with conservative treatment. Three patients (5%) developed recurrent disc herniation requiring revision surgery.
Conclusions: PTED performed under low-dose analgesic spinal anesthesia appears to be a safe and reproducible minimally invasive procedure, providing durable pain relief, functional recovery, and preservation of intraoperative neurological monitoring.