{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,26]],"date-time":"2026-10-26T18:02:11Z","timestamp":1793037731565,"version":"4.5.0"},"reference-count":30,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,1,8]],"date-time":"2026-01-08T00:00:00Z","timestamp":1767830400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Neurol."],"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To investigate whether limited discectomy versus aggressive disc removal influences postoperative neurological recovery in lumbar disc herniation patients undergoing transforaminal endoscopic discectomy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      This retrospective cohort study analyzed 288 patients undergoing percutaneous endoscopic lumbar discectomy (PELD) at our institution between January 2022 and January 2025. Patients were stratified by surgical approach based on established criteria: Aggressive Discectomy Group (comprehensive removal of herniated disc and extensive nucleus pulposus extraction,\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009135) versus Limited Discectomy Group (selective neural decompression preserving disc architecture,\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009153). Primary outcome was neurological recovery at 6\u2009months, assessed via MRC motor grading and sensory function testing. Secondary outcomes included visual analog scale (VAS) pain scores, Oswestry disability index (ODI), operative duration, and complications.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Both groups demonstrated significant improvement in neurological function from baseline to 6\u2009months postoperatively. No significant differences emerged between groups regarding sensory function recovery (normal\/reduced sensation at 6\u2009months: 126\/9 vs. 149\/4,\n                      <jats:italic>\u03c7<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u20092.732,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.098) or motor strength recovery. Mean VAS scores declined from 5.41\u2009\u00b1\u20091.06 to 0.40\u2009\u00b1\u20090.55 (Aggressive group) and from 5.39\u2009\u00b1\u20091.23 to 0.53\u2009\u00b1\u20090.61 (Limited group) with no significant between-group differences (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&amp;gt;\u20090.05). ODI scores improved from 61.96\u2009\u00b1\u20098.52 to 23.21\u2009\u00b1\u20094.53 (Aggressive group) and from 63.62\u2009\u00b1\u20097.96 to 22.63\u2009\u00b1\u20094.82 (Limited group,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&amp;gt;\u20090.05). However, operative duration was significantly shorter in the Limited Discectomy Group (100.41\u2009\u00b1\u200932.33 vs. 108.48\u2009\u00b1\u200931.61\u2009min,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.034). No infections, hematomas, nerve root injuries, or recurrences occurred in either group during follow-up.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Limited discectomy achieved equivalent neurological recovery outcomes compared to aggressive disc removal while requiring significantly less operative time. These findings support adopting less extensive surgical approaches when adequate neural decompression can be accomplished, potentially reducing surgical trauma while maintaining therapeutic efficacy. While these 6-month findings support limited discectomy for early recovery, longer follow-up studies are needed to assess medium to long-term outcomes including recurrence rates and degenerative changes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fneur.2025.1728213","type":"journal-article","created":{"date-parts":[[2026,1,8]],"date-time":"2026-01-08T05:11:40Z","timestamp":1767849100000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Effect of transforaminal endoscopic discectomy extent on postoperative neurological recovery in lumbar disc herniation: a retrospective cohort study"],"prefix":"10.3389","volume":"16","author":[{"given":"Liang","family":"Liu","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dong","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xinge","family":"Liu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hao","family":"Fu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yongcun","family":"Geng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,1,8]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"100279","DOI":"10.1016\/j.wnsx.2024.100279","article-title":"Lumbar disc herniation: Epidemiology, clinical and radiologic diagnosis WFNS spine committee recommendations","volume":"22","author":"Pojskic","year":"2024","journal-title":"Med Glas (Zenica) World Neurosurg X"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"e316","DOI":"10.1016\/S2665-9913(23)00098-X","article-title":"Global, regional, and national burden of low back pain, 1990\u20132020: findings from the global burden of disease study 2021","volume":"5","author":"Ferreira","year":"2023","journal-title":"Lancet Rheumatol"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"968","DOI":"10.1136\/annrheumdis-2013-204428","article-title":"The global burden of low back pain: estimates from the global burden of disease 2010 study","volume":"73","author":"Hoy","year":"2014","journal-title":"Ann Rheum Dis"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"81","DOI":"10.1186\/s12891-025-08326-3","article-title":"Global, regional, and national burden of low back pain for adults aged 55 and older, 1990\u20132021: an analysis for the global burden of disease study 2021","volume":"26","author":"Xu","year":"2025","journal-title":"BMC Musculoskelet Disord"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"e51445","DOI":"10.7759\/cureus.51445","article-title":"Chiropractic management of lumbar disc herniation in a patient with co-existing liver cancer: a case report","volume":"16","author":"Chu","year":"2024","journal-title":"Cureus"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"e36545","DOI":"10.7759\/cureus.36545","article-title":"A severe disc herniation mimics spinal tumor","volume":"15","author":"Chu","year":"2023","journal-title":"Cureus"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"263","DOI":"10.1007\/s00586-024-08528-8","article-title":"Incidence of and risk factors for lumbar disc herniation with radiculopathy in adults: a systematic review","volume":"34","author":"Hincapi\u00e9","year":"2025","journal-title":"Eur Spine J"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"931","DOI":"10.1097\/BRS.0b013e31816c8af7","article-title":"Full-endoscopic interlaminar and transforaminal lumbar discectomy versus conventional microdiscectomy: a prospective, randomized, controlled study","volume":"33","author":"Ruetten","year":"2008","journal-title":"Spine"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"722","DOI":"10.1097\/00007632-200204010-00009","article-title":"Posterolateral endoscopic excision for lumbar disc herniation: surgical technique, outcome, and complications in 307 consecutive cases","volume":"27","author":"Yeung","year":"2002","journal-title":"Spine"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"534","DOI":"10.1016\/j.ijsu.2014.02.015","article-title":"Comparison of tissue damages caused by endoscopic lumbar discectomy and traditional lumbar discectomy: a meta-analysis","volume":"12","author":"Pan","year":"2014","journal-title":"Int J Surg"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"96","DOI":"10.1186\/s13018-024-04543-z","article-title":"Percutaneous endoscopic transforaminal vs. interlaminar lumbar discectomy for L5-S1 disc herniation: a retrospective cohort study","volume":"19","author":"Li","year":"2024","journal-title":"J Orthop Surg Res"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"1021","DOI":"10.3390\/diagnostics15081021","article-title":"Effectiveness and safety of transforaminal spinal endoscopy: analysis of 1000 clinical cases","volume":"15","author":"Tornatore","year":"2025","journal-title":"Diagnostics (Basel)"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"158","DOI":"10.21037\/jss.2016.09.03","article-title":"Advantages and disadvantages of posterolateral approach for percutaneous endoscopic lumbar discectomy","volume":"2","author":"Yokosuka","year":"2016","journal-title":"J Spine Surg"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"337","DOI":"10.36076\/ppj.2018.4.337","article-title":"Prevalence of recurrent herniation following percutaneous endoscopic lumbar discectomy: a meta-analysis","volume":"21","author":"Yin","year":"2018","journal-title":"Pain Physician"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"338","DOI":"10.1227\/01.NEU.0000337574.58662.E2","article-title":"Recurrent disc herniation and long-term back pain after primary lumbar discectomy: review of outcomes reported for limited versus aggressive disc removal","volume":"64","author":"McGirt","year":"2009","journal-title":"Neurosurgery"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"58","DOI":"10.1186\/s12891-020-03891-1","article-title":"Functional outcomes of full-endoscopic spine surgery for high-grade migrated lumbar disc herniation: a prospective registry-based cohort study with more than 5 years of follow-up","volume":"22","author":"Wu","year":"2021","journal-title":"BMC Musculoskelet Disord"},{"key":"ref17","volume-title":"Aids to the examination of the peripheral nervous system, memorandum no. 45","year":"1976"},{"key":"ref18","article-title":"Muscle strength grading","volume-title":"StatPearls","author":"Naqvi","year":"2023"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"1639","DOI":"10.1093\/brain\/awr318","article-title":"Modifying the Medical Research Council grading system through Rasch analyses","volume":"135","author":"Vanhoutte","year":"2012","journal-title":"Brain"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"245","DOI":"10.1016\/j.jpain.2018.07.009","article-title":"Measurement properties of visual analogue scale, numeric rating scale, and pain severity subscale of the brief pain inventory in patients with low back pain: a systematic review","volume":"20","author":"Chiarotto","year":"2019","journal-title":"J Pain"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"2940","DOI":"10.1097\/00007632-200011150-00017","article-title":"The Oswestry disability index","volume":"25","author":"Fairbank","year":"2000","journal-title":"Spine"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"1860","DOI":"10.1016\/j.spinee.2013.10.027","article-title":"Oswestry disability index is a better indicator of lumbar motion than the visual analogue scale","volume":"14","author":"Ruiz","year":"2014","journal-title":"Spine J"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"E3","DOI":"10.3171\/2015.10.FOCUS15484","article-title":"Clinical outcomes after percutaneous transforaminal endoscopic discectomy for lumbar disc herniation: a prospective case series","volume":"40","author":"Gadjradj","year":"2016","journal-title":"Neurosurg Focus"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"607","DOI":"10.1186\/s13018-024-05269-8","article-title":"Efficacy of percutaneous endoscopic lumbar discectomy (PELD) combined with sinuvertebral nerve ablation for low back pain in lumbar disc herniation: a retrospective cohort study","volume":"19","author":"Huang","year":"2024","journal-title":"J Orthop Surg Res"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"416","DOI":"10.1186\/s12891-024-07498-8","article-title":"Limited discectomy versus aggressive discectomy by spinal endoscopy with the transforaminal approach for lumbar disc herniation: a retrospective study","volume":"25","author":"Reheman","year":"2024","journal-title":"BMC Musculoskelet Disord"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"240","DOI":"10.1016\/j.spinee.2008.08.005","article-title":"An evidence-based review of the literature on the consequences of conservative versus aggressive discectomy for the treatment of primary disc herniation with radiculopathy","volume":"9","author":"Watters","year":"2009","journal-title":"Spine J"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"3","DOI":"10.1097\/BRS.0000000000000088","article-title":"Surgical versus non-operative treatment for lumbar disc herniation: eight-year results for the spine patient outcomes research trial","volume":"39","author":"Lurie","year":"2014","journal-title":"Spine"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"46","DOI":"10.1055\/s-0035-1570344","article-title":"Effect of annular defects on intradiscal pressures in the lumbar spine: an in vitro biomechanical study of diskectomy and annular repair","volume":"78","author":"Bostelmann","year":"2017","journal-title":"J Neurol Surg A Cent Eur Neurosurg"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"979","DOI":"10.1186\/s13018-023-04476-z","article-title":"Finite element mechanical analysis of ipsilateral approach and contralateral approach in unilateral bilateral endoscopic spine surgery","volume":"18","author":"Li","year":"2023","journal-title":"J Orthop Surg Res"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"1459","DOI":"10.1007\/s00586-010-1433-7","article-title":"Clinical factors of importance for outcome after lumbar disc herniation surgery: long-term follow-up","volume":"19","author":"Silverplats","year":"2010","journal-title":"Eur Spine J"}],"container-title":["Frontiers in Neurology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fneur.2025.1728213\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,8]],"date-time":"2026-01-08T05:11:44Z","timestamp":1767849104000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fneur.2025.1728213\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,8]]},"references-count":30,"alternative-id":["10.3389\/fneur.2025.1728213"],"URL":"https:\/\/doi.org\/10.3389\/fneur.2025.1728213","relation":{},"ISSN":["1664-2295"],"issn-type":[{"value":"1664-2295","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,8]]},"article-number":"1728213"}}