Objective: Lumbar spinal stenosis is a medical condition characterized by the narrowing of the spinal canal as a consequence of bone and soft tissue degeneration, including disc herniation, facet and ligamentum flavum hypertrophy, and osteophyte formation. The percutaneous transforaminal endoscopic discectomy (PTED) technique is one of the emerging surgical alternatives for treating central lumbar stenosis. The present study aims to describe the present techniques of PTED and foraminoplasty for central lumbar stenosis, and discuss the feasibility and advantages of this technique.Conclusion: PTED and foraminoplasty technique showed promising outcomes in the treatment of central lumbar stenosis in a 1-year follow-up period. It suggested that PTED and foraminoplasty might be applied as a safe and effective therapeutic option for patients with lumbar stenosis.

Intervertebral disc degeneration (IDD), an important cause of chronic low back pain (LBP), is considered the pathological basis for various spinal degenerative diseases. A series of factors, including inflammatory response, oxidative stress, autophagy, abnormal mechanical stress, nutritional deficiency, and genetics, lead to reduced extracellular matrix (ECM) synthesis by intervertebral disc (IVD) cells and accelerate IDD progression. Mammalian target of rapamycin (mTOR) is an evolutionarily conserved serine/threonine kinase that plays a vital role in diverse degenerative diseases. Recent studies have shown that mTOR signalling is involved in the regulation of autophagy, oxidative stress, inflammatory responses, ECM homeostasis, cellular senescence, and apoptosis in IVD cells. Accordingly, we reviewed the mechanism of mTOR signalling in the pathogenesis of IDD to provide innovative ideas for future research and IDD treatment.

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Background Percutaneous transforaminal endoscopic discectomy (PTED) and micro-endoscopic discectomy (MED) are alternative minimally invasive, widely performed procedures for the treatment of lumbar disc herniation (LDH). This study compared the clinical outcomes of these 2 surgical techniques in treating LDH. Material/Methods A comprehensive literature search was performed in PubMed, MEDLINE, EMBASE, Cochrane, and Google Scholar to identify all relevant studies comparing PTED and MED in treating LDH. Results Eight comparative studies assessing a total of 805 patients were included for the final analysis. The results indicated that PTED needs a shorter incision [−1.02 (−1.21 to −0.83), p<0.001], less time in bed [−2.14 (−3.34 to −0.94), p<0.001], and shorter hospital stay [−1.92 (−2.90 to −0.94), p<0.001], whereas MED is superior regarding intraoperative fluoroscopy [7.47 (2.78 to 12.17), p=0.002] and total cost [0.69 (0.38 to 1.00), p<0.001]. No significant differences were found on operation time, intraoperative blood loss, or complications. Significant lower back pain was found in the PTED group at 1 week postoperatively [−0.52 (−0.95 to −0.10), p=0.02] and 1 year postoperatively or the last follow-up [−0.41 (−0.76 to −0.06), p=0.02]; significant lower leg pain was also detected at 1 week postoperatively [−0.52 (−0.75 to −0.30), p<0.001]. Oswestry Disability Index (ODI) was significant better at 1 week postoperatively in the PTED group [−4.41 (−7.03 to −1.79), p=0.001]. No significant differences were detected at other time points regarding pain score and ODI. Conclusions Both PTED and MED are safe and effective techniques for treating LDH. However, taking all clinical outcomes together, PTED might be a preferable treatment modality for LDH.