A Retrospective Comparative Study of Modified Percutaneous Endoscopic Transforaminal Discectomy and Open Lumbar Discectomy for Gluteal Pain Caused by Lumbar Disc Herniation

Full-endoscopic lumbar spine discectomy: Are We Finally There? A Meta-Analysis of Its Effectiveness Against Non-microscopic Discectomy, Microdiscectomy and Tubular Discectomy

BACKGROUND CONTEXT

Full-endoscopic lumbar discectomy (FELD) has gained increasing attention as a minimally invasive alternative to conventional microdiscectomy (MD), tubular discectomy (MED), and open non-microscopic discectomy (OD) Despite significant technological advancements in endoscopic techniques over the past decade, it is not yet clear whether FELD offers a definitive advantage over traditional methods.

PURPOSE

This study aims to perform a meta-analysis of available publications to assess whether the superiority of endoscopic treatment over traditional open and minimally invasive endoscopic surgical techniques can be more conclusively established. The central question driving this meta-analysis was: Are we finally there?

STUDY DESIGN/SETTING

Meta-analysis study included adult patients (≥18 years old) with symptomatic lumbar disc herniation (LDH) without concurrent lumbar spinal stenosis METHODS: A systematic review was conducted in PubMed, Embase, Web of Science, and the Cochrane Library for randomized or nonrandomized controlled trials published between 2013 and 2024. The quality of randomized controlled trials and cohort studies was assessed using the Revised Cochrane risk-of-bias tool and Newcastle-Ottawa Scale, respectively. Included studies reported on at least one of the following outcomes: (1) adverse effects, (2) operative parameters, (3) bed and hospital stay, and (4) clinical indices (postoperative values). Mean differences (MDs) or odds ratios (ORs) were used to compare treatment effects between FELD and MD, MED, or OD.

RESULTS

FELD demonstrated several advantages, particularly in short-term pain (within 6 months postoperatively) relief and faster patient (length of bed stay 1-2 days) mobilization, while maintaining comparable risks of recurrence, reoperation, and complications relative to traditional techniques. However, there is substantial heterogeneity in the data and a limited number of prospective trials.

CONCLUSIONS

More well-designed, prospective randomized trials are necessary, with a focus on radiological outcomes and comprehensive cost analyses including societal costs. Only through such robust data can we determine whether FELD truly represents a new gold standard for lumbar discectomy. Are we finally there? We are certainly closer, but much remains to be addressed.

Economic comparisons of endoscopic spine surgery: a systematic review

PURPOSE

Full-endoscopic techniques are minimally invasive surgery alternatives to traditional spinal surgery. We performed a systematic review of the literature to assess the costs of these techniques compared to traditional approaches.

METHODS

A systematic review of the literature was performed for economic evaluations that compare endoscopic decompressions of the lumbar spine for stenosis or disc herniation to open or microsurgical decompressions. The search was performed in the following databases: Medline, Embase Classic, Embase, and Central Cochrane library, from January 1, 2005, to October 22, 2022. The included studies were each evaluated according to a formal assessment checklist to evaluate the quality of economic evaluations based on 35 criteria.

RESULT

A total of 1153 studies were identified, with 9 articles included in the final analysis. In evaluating the quality of economic evaluations, the study with the fewest met criteria scored 9/35 and the study with the most met criteria scored 28/35. Only 3 studies completed cost-effectiveness analyses. Surgical procedure duration varied between studies, but hospital length of stays were consistently shorter with endoscopy. While endoscopy was more frequently associated with higher operating costs, studies that measured healthcare and societal costs found endoscopy to be advantageous.

CONCLUSION

Endoscopic spine surgery was found to be cost-effective in treating patients with lumbar stenosis and disc herniation when compared to standard microscopic approaches from a societal perspective. More well-designed economic evaluations investigating the cost-effectiveness of endoscopic spine procedures are needed to further support these findings.