Full Endoscopic versus Microscopic Lumbar Discectomy for Lumbar Disc Herniation: A Meta-analysis of...

Area of Science:

• Neurosurgery
• Minimally Invasive Spine Surgery
• Orthopedic Surgery

Background:

• Full endoscopic discectomy (FED) aims to minimize soft tissue injury compared to microscopic discectomy (MSD).
• Previous reviews often included heterogeneous minimally invasive techniques or non-randomized studies, limiting current practice applicability.
• Understanding the comparative efficacy and safety of contemporary FED versus MSD is crucial.

Purpose of the Study:

• To systematically compare safety, recovery metrics, and patient-reported outcomes between FED and MSD for lumbar disc herniation (LDH).
• To provide an evidence-based synthesis of randomized controlled trials (RCTs) for current clinical decision-making.

Main Methods:

• A systematic review and meta-analysis of RCTs comparing FED and MSD in adult patients with LDH.
• Searches were conducted in PubMed, Embase, and CENTRAL.
• Key outcomes included complications, pain scores (VAS), disability (ODI), and perioperative measures. Risk of bias (RoB 2) and certainty of evidence (GRADE) were assessed.

Main Results:

• Seventeen RCTs with 2238 patients (FED: 1070; MSD: 1168) were analyzed.
• Leg pain outcomes were comparable; FED showed a trend towards better back pain relief at 1 year and improved ODI at 2 years.
• FED significantly reduced blood loss, wound complications (infection, poor healing, hematoma), and time to return to work, but increased radiation exposure. Operative time and length of stay were similar.

Conclusions:

• FED and MSD demonstrate comparable efficacy in decompression and patient-reported outcomes for LDH.
• FED offers advantages in reduced wound morbidity and potentially faster return to work.
• The benefits of FED are balanced against increased fluoroscopic exposure, with no consistent long-term superiority in pain or disability outcomes.