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Beyond the Microscope: Is Endoscopic Discectomy the Next Gold Standard for Lumbar Disc Herniation?
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DOI：10.14245/ns.2551450.725.png)
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Abstract
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Objective: This systematic review and meta-analysis aimed to compare endoscopic discectomy (ED) with microdiscectomy (MD) for lumbar disc herniation, evaluating patient-reported outcomes, perioperative parameters, and complications to determine if ED could replace MD as the gold standard. Methods: Following PRISMA (Preferred Reporting Items for Systematic Reviews and Metaanalyses) guidelines, we searched PubMed, Embase, Scopus, and Web of Science (January 2000-June 2025) for randomized controlled trials (RCTs) and prospective cohort studies comparing MD with ED subtypes (transforaminal endoscopic lumbar discectomy [TELD], interlaminar endoscopic lumbar discectomy [IELD], and unilateral biportal endoscopy [UBE]). Outcomes included Oswestry Disability Index (ODI), visual analogue scale (VAS) for pain, operative time, hospital stay, complications, and recurrence. Pooled mean differences and odds ratios (ORs) were calculated using random-effects models, with subgroup analyses by ED subtype. Risk of bias was assessed using RoB 2.0 and ROBINS-I tools. Results: Seventeen studies (9 RCTs, 8 cohorts; n = 3,115) were included. ED significantly reduced hospital stay (mean difference, -2.43 days; 95% CI, -3.62 to -1.23; p <0.05) and showed greater short-term ODI improvement (mean difference, 2.13; 95% CI, 0.58-3.67). No differences were observed in operative time, long-term ODI, or VAS scores. ED had lower wound complications but a higher recurrence risk with TELD (OR, similar to 2.0). High heterogeneity (I-2 > 95%) and limited long-term data (> 2 years) were noted. Conclusion: ED offers perioperative advantages and comparable efficacy but does not surpass MD due to TELD's increased recurrence risk. IELD and UBE are promising alternatives, but MD remains the benchmark. Long-term RCTs are needed.
Keywords:
Lumbar disc herniation
Endoscopic discectomy
Microdiscectomy
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