Comparison of full endoscopic lumbar discectomy combined with and without platelet-rich plasma injections for lumbar disc herniation: a meta-analysis.

Study design: A meta-analysis study.

Purpose: To compare the clinical efficacy and safety of combining full endoscopic lumbar discectomy (FELD) with platelet-rich plasma (PRP) administration versus FELD alone in treating lumbar disc herniation (LDH).

Overview of literature: FELD is effective for LDH, but PRP may enhance healing; evidence comparing both remains unclear.

Methods: A systematic literature search was conducted in PubMed, Embase, Web of Science, China National Knowledge Infrastructure, and Wanfang Data up to December 20, 2023. Primary outcomes included postoperative Visual Analog Scale (VAS) pain scores, Oswestry Disability Index (ODI), and Japanese Orthopaedic Association (JOA) scores. Secondary outcomes included disc height, complications, and Pfirrmann grade of disc degeneration.

Results: Six studies involving 433 patients were included (214 undergoing FELD combined with PRP and 219 undergoing FELD alone). Patients in the FELD+PRP group had significantly lower VAS scores for back pain after surgery compared to the FELD group (p <0.05). JOA and ODI scores showed significantly better improvement in the FELD+PRP group than in the FELD group (p <0.05). Compared to the FELD group, the FELD+PRP group had less disc height loss and a lower complication rate (p =0.0005). There was a significantly better improvement in disc degeneration (based on Pfirrmann grading) at final follow-up in the FELD+PRP group compared to the FELD group (p =0.002).

Conclusions: The combination of FELD and PRP offers superior outcomes compared to FELD alone in the treatment of LDH, including a more pronounced relief from back pain, significant functional improvement, and fewer postoperative complications. Additionally, it facilitates the repair of the annulus fibrosus of the intervertebral disc and reduces the loss of disc height.