Comparative effectiveness of minimally invasive endoscopic discectomy versus conventional surgical techniques for lumbar disc herniation: a systematic review and meta-analysis.

BACKGROUND

While traditional open discectomy is the standard surgical treatment for lumbar disc herniation (LDH), minimally invasive endoscopic techniques have emerged as potential alternatives. This systematic review and meta-analysis evaluated the comparative effectiveness of endoscopic discectomy (ED) and conventional surgical techniques (CT).

METHODS

A comprehensive search of the PubMed, Scopus, Cochrane Library, and Web of Science databases was conducted through January 2025. Randomized controlled trials and high-quality observational studies comparing ED and CT for LDH were included. Primary outcomes included Visual Analog Scale scores for back and leg pain (VAS-Back and VAS-Leg) and the Oswestry Disability Index (ODI). The secondary outcomes included complication rates, reoperation rates, and length of hospital stay.

RESULTS

Fourteen studies (1795 participants) met the inclusion criteria. Meta-analysis revealed no significant differences between ED and CT in terms of VAS-Back [standardized mean difference (SMD): 0.02; 95% CI: -0.15 to 0.19], VAS-Leg (SMD: -0.02; 95% CI: -0.19 to 0.16), or ODI scores (SMD: -0.09; 95% CI: -0.27 to 0.08). The complication rates (RR: 0.85; 95% CI: 0.55-1.31) and reoperation rates (RR: 1.00; 95% CI: 0.75-1.33) were comparable between the groups. ED was associated with a significantly shorter hospital stay (SMD: -2.40; 95% CI: -4.31 to -0.49).

CONCLUSION

Minimally invasive ED is comparable to CTs in terms of pain relief, functional improvement, and safety profiles, while potentially offering the advantage of a shorter hospital stay. These findings support the viability of endoscopic approaches as effective alternatives to traditional surgery for LDH, although the surgical technique selection should be individualized based on patient characteristics, surgeon expertise, and available resources.