Comparing percutaneous transforaminal endoscopic discectomy and micro-endoscopic discectomy in the treatment of lumbar disc herniation: An updated systematic review and meta-analysis of cohort and RCT.

BACKGROUND

Percutaneous transforaminal endoscopic discectomy (PTED) and micro-endoscopic discectomy (MED) are common minimally invasive techniques for lumbar disc herniation (LDH). This updated systematic review and meta-analysis compare both procedures, incorporating studies published since 2019.

METHODS

Following PRISMA guidelines, PubMed, Cochrane Library, and Google Scholar were searched for cohort studies and randomized controlled trials comparing PTED and MED. Primary outcomes were Oswestry Disability Index (ODI) and Visual Analog Scale (VAS) scores. Secondary outcomes included hospital stay, intraoperative blood loss, complications, and recurrence. The review protocol was prospectively registered in the PROSPERO database (Registration ID: CRD42025110).

RESULTS

Thirteen studies (n = 2453) were included in the meta-analysis. No significant differences were found in ODI at 6 months, 1 year, or 2 years. However, PTED consistently showed greater reduction in back pain (VAS), with significant differences at 6 months (MD = -0.34), 1 year (MD = -0.59), and 2 years (MD = -0.48). No significant differences were found for leg pain (VAS) at any time point. PTED was also associated with shorter hospital stays (MD = -2.69 days) and reduced intraoperative blood loss (MD = -12.94 ml). Complication and recurrence rates were comparable between groups (RR = 0.84 and 1.10, respectively). High heterogeneity was noted for VAS back pain, hospital stay, blood loss, and recurrence (I2 = 60-99%).

CONCLUSION

PTED and MED yield comparable long-term functional outcomes and safety. PTED provides more sustained back pain relief, faster recovery, less blood loss, and shorter hospitalization, whereas MED may offer advantages in lower radiation exposure and cost. Overall, PTED is a safe and effective alternative to MED, and the choice of technique should be guided by patient characteristics, resource availability, and surgeon expertise.