A meta-analysis of percutaneous endoscopic discectomy and microdiscectomy for lumbar disc herniation: assessing surgical efficacy and clinical outcomes.

Background: Lumbar disc herniation is one of the commonest conditions affecting the lumbar spine, with disc fragments migrating in 35-72% of patients. It can be treated with either microdiscectomy or percutaneous endoscopic lumbar discectomy (PELD) surgeries.

Materials and methods: We searched these databases; Web of Science, PubMed, Cochrane Library, and SCOPUS. Overall, 26 studies, both randomized controlled trials and observational studies, were included. We analyzed different efficacy, safety, and functional outcomes including operation time, estimated blood loss (EBL), length of hospital stay, return to work period, pain scores, functional outcomes (Oswestry Disability Index (ODI) index, MacNab classification), and rates of complications, recurrence, and reoperation.

Results: Our results revealed that PELD was superior to MD in different studied outcomes including operation times (mean difference (MD) = -7.97 minutes, p = 0.004), I2 = 69%, return to work (MD = -3.21 weeks, p = 0.001), I2 = 52%, complication rates (OR = 0.70, p = 0.02), I2 = 23%, back pain (OR = -0.30, p = 0.001), and ODI scores (MD = -1.64%, p = 0.002). Both cohorts showed similar outcomes for leg pain (p = 0.31) and recurrence rates (p = 0.87). The rates of reoperation were higher in the PELD cohort compared to MD (OR = 1.47, p = 0.04).

Conclusion: PELD had better results than the MD group in most of our efficacy, safety, and clinical outcomes including ODI score, surgical time, blood loss, overall complications, and hospital stay while being comparable in the rest of the parameters assessed.