{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,11]],"date-time":"2026-08-11T05:11:30Z","timestamp":1786425090147,"version":"build-2736575974"},"reference-count":28,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2024,7,3]],"date-time":"2024-07-03T00:00:00Z","timestamp":1719964800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Orthopaedic Surgery"],"published-print":{"date-parts":[[2024,8]]},"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>Currently, there is no established guideline on whether to opt for percutaneous endoscopic lumbar discectomy (PELD) or traditional transforaminal lumbar interbody fusion (TLIF) surgery based on specific types of lumbar disc herniation (LDH). Based on the Michigan State University (MSU) classification system, this study conducted a medium\u2010 to long\u2010term follow\u2010up analysis of two surgical methods over 5\u2009years for the first time, aiming to provide empirical evidence to assist in making more informed decisions before surgery for LDH treatment.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This was a retrospective study that included 273 patients with single\u2010level LDH who underwent PELD or TLIF treatment at our hospital between January 1, 2016, and December 31, 2018. Detailed metrics included preoperative and postoperative visual analogue scale (VAS) scores and Oswestry disability index (ODI) at 1\u2010day, 1\u2010week, 1\u2010year, and 5\u2010year follow\u2010ups. Complications, recurrences, and 5\u2010year postoperative modified MacNab criteria scores were also recorded. Statistical methods included independent sample <jats:italic>t<\/jats:italic>\u2010tests, repeated measures analysis of variance (ANOVA), and <jats:italic>\u03c7<\/jats:italic><jats:sup>2<\/jats:sup> tests.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Classified into seven groups according to the MSU classification, it was found that there was an improvement in the VAS and ODI scores at four postoperative follow\u2010ups (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001). PELD showed better results than TLIF in reducing pain and improving the ODI scores in the classifications of 3B, 2B, and 2C (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.05). TLIF demonstrated consistent superiority over PELD in 2A, 2AB, 3A, and 3AB classifications (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.05). The total recurrence rate in the PELD group (11.05%) within 5\u2009years after surgery was higher (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.05) than that in the TLIF group (3.96%). These were mainly concentrated in the 2A, 2AB, 3A, and 3AB types. Moreover, the rate of excellent and good outcomes in the PELD was higher than in the TLIF but no significant difference (<jats:italic>\u03c7<\/jats:italic><jats:sup>2<\/jats:sup>\u2009=\u20091.0568, <jats:italic>p<\/jats:italic>\u2009=\u20090.5895).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>This study suggests that PELD and TLIF may relieve LDH, but have advantages under different MSU classifications. The MSU classification has specific guiding significance and could aid in the surgical selection of PELD or TLIF to achieve optimal treatment outcomes for patients with lumbar disc herniation.<\/jats:p><\/jats:sec>","DOI":"10.1111\/os.14145","type":"journal-article","created":{"date-parts":[[2024,7,4]],"date-time":"2024-07-04T06:10:32Z","timestamp":1720073432000},"page":"1963-1973","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Surgical Strategy for Lumbar Disc Herniation based on the <scp>MSU<\/scp> Classification: Percutaneous Endoscopic Lumbar Discectomy versus Transforaminal Lumbar Interbody Fusion: A 5\u2010year Retrospective Study"],"prefix":"10.1111","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9377-6734","authenticated-orcid":false,"given":"Hongtao","family":"Li","sequence":"first","affiliation":[{"name":"Department of Spine Surgery The Affiliated Traditional Chinese Medicine Hospital, Southwest Medical University  Luzhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-5679-6804","authenticated-orcid":false,"given":"Changming","family":"Xiao","sequence":"additional","affiliation":[{"name":"Department of Spine Surgery The Affiliated Traditional Chinese Medicine Hospital, Southwest Medical University  Luzhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4889-5600","authenticated-orcid":false,"given":"Hongyu","family":"Pan","sequence":"additional","affiliation":[{"name":"Department of Spine Surgery The Affiliated Traditional Chinese Medicine Hospital, Southwest Medical University  Luzhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haomiao","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Spine Surgery The Nanjing TCM Hospital Affiliated to Nanjing University of Traditional Chinese Medicine  Nanjing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yang","family":"Lei","sequence":"additional","affiliation":[{"name":"Department of Spine Surgery The Affiliated Traditional Chinese Medicine Hospital, Southwest Medical University  Luzhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7828-7318","authenticated-orcid":false,"given":"Haozhong","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Spine Surgery The Affiliated Traditional Chinese Medicine Hospital, Southwest Medical University  Luzhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sen","family":"Li","sequence":"additional","affiliation":[{"name":"Division of Spine Surgery, Department of Orthopedic Surgery Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University  Nanjing 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