Full-endoscopic versus microscopic lumbar discectomy for lumbar disc herniation: a systematic review and meta-analysis of 4,186 cases.

BACKGROUND CONTEXT: Full-endoscopic lumbar discectomy for disc herniation has gained attention as a minimally invasive technique aimed at reducing approach-related morbidity while achieving similar outcomes to more conventional microscopic discectomy techniques.

PURPOSE: To assess the safety and efficacy of full-endoscopic versus microscopic lumbar discectomy for the treatment of lumbar disc herniation.

STUDY

DESIGN

Systematic review and meta-analysis.

METHODS

A systematic review of randomised and nonrandomised studies comparing full-endoscopic and microscopic lumbar discectomy was conducted in accordance with the PRISMA guidelines. Treatment effects were estimated using pairwise random-effects meta-analysis. Quality assessment was evaluated using the Joanna Briggs Institute Critical Appraisal Tool.

RESULTS

A total of 28 primary references comprising 4,186 patients were included. Endoscopic decompression was associated with significantly shorter time to return to work (WMD=-22.61 days, 95% CI: -34.15 to -11.08, p<.01), shorter length of hospital stay (WMD=-2.20 days, 95% CI: -3.16 to -1.24, p<.01), lower risk of postoperative infections (RR=0.38, 95% CI: 0.18 to 0.80, p=.95), and lower risk of delayed wound healing, poor wound healing, and wound dehiscence (RR=0.20, 95% CI: 0.04 to 0.91, p=.93). However, endoscopic decompression was also associated with a higher risk of postoperative dysesthesia (RR=2.28, 95% CI: 1.12 to 4.61, p=.56).

CONCLUSION

Full-endoscopic and microscopic decompression are safe and effective techniques for treatment of symptomatic lumbar disc herniation. Prospective studies of larger power considering medium to long-term outcomes and rates of iatrogenic instability are warranted to substantiate findings from the present study.