Biportal endoscopic versus microscopic discectomy for lumbar herniated disc: a randomized controlled trial

Area of Science:

• Minimally invasive spinal surgery
• Neurosurgery
• Orthopedic surgery

Background:

• Biportal endoscopic discectomy is increasingly used for lumbar disc herniation.
• Limited evidence exists on its comparative efficacy and safety against traditional methods.

Purpose of the Study:

• To compare the clinical efficacy and safety of biportal endoscopic discectomy versus open microscopic discectomy for single-level herniated lumbar discs.

Main Methods:

• A prospective, randomized, multicenter, open-label, assessor-blind, non-inferiority trial.
• 64 patients with single-level herniated lumbar discs were randomized (1:1) to biportal endoscopic or microscopic discectomy.
• Outcomes included Oswestry Disability Index (ODI), pain scores (VAS), quality of life (EQ-5D), and surgery-related metrics.

Main Results:

• Biportal endoscopic discectomy was non-inferior to microscopic discectomy in ODI scores at 12 months (mean difference 1.92).
• Lower creatinine phosphokinase ratios and reduced early surgical site pain (VAS) were observed in the biportal group.
• No significant differences in adverse events or reoperations were found between the groups.

Conclusions:

• Biportal endoscopic discectomy demonstrates non-inferiority to microscopic discectomy for lumbar disc herniation over 12 months.
• It is a safe and effective technique with potential benefits of reduced muscle damage and early pain.
• Careful consideration of surgical site pain implications is warranted.