PEID plus medical chitosan improves pain scores and reduces complications in L4-5 LDHAdding chitosan to surgery may reduce pain for disc herniation

European journal of orthopaedic surgery & traumatology : orthopedie traumatologie Published August 6, 2026 Study authors: Cao Liying, Zhang Jun, Jiang Mingjing, Lin Binzhen, Zhong Nan, Yin Xiaofeng, Guan Yiyun, Huang Xiaoc… PubMed ↗ DOI ↗ Editorial oversight: Dr. Lars van Dijk, PhD · Surgical, Procedural & Diagnostic

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Key Takeaway

Consider PEID plus medical chitosan to potentially reduce pain and complication rates in L4-5 LDH patients.

This randomized controlled trial enrolled 200 patients with lumbar 4-5 disc herniation (L4-5 LDH) to evaluate the efficacy of ultrasound-guided percutaneous endoscopic interlaminar discectomy (PEID). The study compared a group receiving PEID plus medical chitosan against a control group receiving only ultrasound-guided PEID.

At 2 weeks postoperatively, the observation group (PEID plus chitosan) demonstrated superior treatment efficacy. Significant differences were observed in primary outcomes including Visual Analog Scale (VAS), Japanese Orthopaedic Association (JOA), and Oswestry Disability Index (ODI) scores compared to the control group. Specifically, the intervention group showed reduced VAS and ODI scores and increased JOA scores.

Regarding safety, the observation group reported a lower complication incidence than the control group based on modified MacNab criteria. Specific adverse event rates or tolerability data were not reported. The study's short follow-up period of 2 weeks limits the ability to assess long-term outcomes for L4-5 LDH patients.

How this fits prior evidence

How this fits prior evidence: This finding extends existing knowledge on surgical interventions for lumbar disc herniation by evaluating a specific pharmacological adjunct, medical chitosan, to ultrasound-guided PEID. While previous coverage noted that PEID reduces operative time and fluoroscopy frequency compared to PETD, this study specifically addresses the addition of chitosan to improve immediate postoperative pain and reduce complications. It adds to the range of available treatments alongside previously covered options like yaobitong capsules and moxibustion-based therapies.

Living with a lumbar disc herniation means dealing with constant back and leg pain. For many, the standard of care involves a procedure called ultrasound-guided PEID. This study looked at what happens when doctors add medical chitosan to that surgical process.

Researchers tracked 200 patients to see if adding chitosan made a difference. At the two-week mark after surgery, patients who received both the surgery and chitosan showed better results than those who only had the surgery. Specifically, these patients reported lower pain scores and better mobility in their daily lives.

Beyond just managing pain, the group that received chitosan also had fewer complications during the surgical period. While this trial shows a promising link between chitosan and better recovery for lumbar disc herniation, it is important to talk with your doctor about how these specific results apply to your personal treatment plan.

What this means for you:

Adding chitosan to surgery for lumbar disc herniation may reduce pain and lower the risk of complications.

Common questions

What is the benefit of using chitosan with this surgery?

Patients who received both the ultrasound-guided PEID surgery and medical chitosan showed better results at two weeks postoperatively. They reported lower pain scores on the Visual Analog Scale and improved mobility on the Oswestry Disability Index compared to those who only had the surgery.

Does adding chitosan make the procedure safer?

The study found that patients in the group receiving both the surgery and medical chitosan had a lower incidence of complications than the control group. This suggests it may help reduce issues during the perioperative period.

Who is this treatment for?

This specific treatment was studied in 200 patients diagnosed with lumbar 4-5 disc herniation. It aims to improve outcomes for those suffering from lower back and leg pain caused by these types of disc issues.

Study Details

Study typeRct

EvidenceLevel 2

PublishedAug 2026

PMID42331761

View Original Abstract ↓

OBJECTIVE: Percutaneous endoscopic lumbar discectomy (PELD) is a preferred minimally invasive surgery for lumbar disc herniation (LDH); however, postoperative recurrence, nerve root damage, and hyperesthesia continue to present key clinical challenges. Chitosan represents a novel preventive approach against postoperative complications. This study aimed to assess the clinical efficacy of ultrasound-guided percutaneous endoscopic interlaminar discectomy (PEID) plus medical chitosan in treating lumbar 4-5 disc herniation (L4-5 LDH). METHODS: Totally, 200 L4-5 LDH patients were prospectively recruited and randomly divided into the control group (ultrasound-guided PEID) and observation group (ultrasound-guided PEID plus medical chitosan). Low back and leg pain and lumbar dysfunction were assessed preoperatively and postoperatively using Visual Analog Scale (VAS), Oswestry Disability Index (ODI), and Japanese Orthopaedic Association (JOA). Efficacy and postoperative complications were evaluated according to the modified MacNab criteria. Logistic regression analyses identified the risk factors. Mann-Whitney U test was used for inter-group comparisons, and the Kruskal-Wallis test for timepoint comparisons. RESULTS: The two groups showed significant differences in pre-treatment Pfirrmann classification and operation time. As time progressed, patients exhibited reduced VAS and ODI scores and increased JOA scores postoperatively. Significant differences were observed in VAS, JOA, and ODI scores in the observation group at 2 weeks postoperatively. The observation group demonstrated superior treatment efficacy and a lower complication incidence than the control group. Age, disease course, and postoperative bleeding were independent risk factors affecting clinical efficacy of ultrasound-guided PEID plus chitosan. CONCLUSION: Ultrasound-guided PEID plus medical chitosan reduces postoperative pain and perioperative complications, demonstrating superior clinical efficacy.

PEID plus medical chitosan improves pain scores and reduces complications in L4-5 LDHAdding chitosan to surgery may reduce pain for disc herniation

How this fits prior evidence

Common questions

Study Details

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PEID plus medical chitosan improves pain scores and reduces complications in L4-5 LDHAdding chitosan to surgery may reduce pain for disc herniation

How this fits prior evidence

Common questions

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