Background and Objectives: For patients with lumbar radiculopathy (LR) with or without radiographic lumbar instability (RLI), it is controversial whether to choose percutaneous endoscopic lumbar discectomy (PELD) treatment. We have previously admitted a large number of patients who recovered from LR treated with PELD, some of whom had RLI and achieved satisfactory outcomes after treatment. The purpose of this study was to investigate the surgical outcomes of patients with LR combined with RLI treated with PELD for decompression only.

Methods: A retrospective analysis included 579 LR patients undergoing PELD. We compared surgical outcomes with imaging changes in LR patients with and without RLI who were matched for age, sex, surgical segmentation, and surgical approach. Outcomes included Oswestry Disability Index (ODI), Japanese Orthopaedic Association (JOA), and visual analog scale (VAS) scores.

Results” A total of 486 patients (83.9%) with complete data were considered eligible for this study. PTED and PEID were performed on 252 and 234 patients, respectively. A total of 73 patients (15.0%) with a combined RLI in lesion segment were treated with percutaneous transforaminal endoscopic discectomy (PTED) in 50 cases and percutaneous endoscopic interlaminar discectomy (PEID) in 23 cases. Comparing the outcomes of the 73 with RLI to the 73 matched patients without RLI, there were no significant differences in preoperative or postoperative outcomes between the two groups, and patients showed improvement in ODI, JOA, and VAS postoperatively during a mean follow-up period of 48.5-month. Radiographic instability persisted in most patients (>78%) postoperatively, with higher rates in older patients with lumbar segmental translational instability (LSTI) and in those with combined LSTI and lumbar segmental rotational instability (LSRI).

Conclusion PELD showed acceptable surgical outcomes regardless of the presence of RLI. In patients of LR with RLI, fusion surgery may not always be necessary.