Abstract:Objective To compare the clinical efficacy of two approaches under spinal endoscopy in the treatment of L_4-5 intervertebral disc herniation. Methods A retrospective analysis was performed for 148 patients with L_4-5 intervertebral disc herniation treated in The Affiliated Huai'an No.1 People's Hospital of Nanjing Medical University from January 2020 to June 2023. Among them, 68 cases were treated with percutaneous endoscopic transforaminal discectomy (PETD group), and 80 cases were treated with percutaneous endoscopic interlaminar discectomy (PEID group). Surgical time, intraoperative fluoroscopy frequency, intraoperative bleeding volume, postoperative hospital stay, and clinical efficacy were compared between two groups. Preoperative and postoperative lumbar Oswestry dysfunction index (ODI), VAS score for lower back and leg pain were compared. Results Patients in both groups were followed up for 6-36 months, with an average of 21.6 month. The surgical time, intraoperative bleeding volume, postoperative hospital stay, and intraoperative fluoroscopy in the PEID group were significantly lower than those in the PETD group (P＜0.05). The VAS scores of lower back and leg pain and ODI scores in the two groups at the first day, one month, three months and the last follow-up after operation were improved compared with those before operation (P＜0.05), but there was no significant difference between the two groups (P＞0.05). There was no significant difference in the excellent and good rate between the PETD group and PEID group (95.6% vs 93.8%, χ2=0.016, P=0.898). Conclusion Both approaches under spinal endoscopy can effectively treat L_4-5 intervertebral disc herniation, but the PEID group has shorter operation time and fewer fluoroscopic times, which can effectively shorten the operation time and anesthesia time.