A comparative study of transforaminal and interlaminar approaches in percutaneous endoscopic lumbar discectomy for L5-S1 disc Herniation: Systematic review

Background: Percutaneous Endoscopic Lumbar Discectomy (PELD) is a leading minimally invasive technique for lumbar disc herniation (LDH). The two primary approaches, transforaminal (PETD) and interlaminar (PEID), each present distinct advantages and challenges in treating L5-S1 LDH. This study aims to compare the efficacy and safety of these two approaches. Methods: A systematic review was conducted using the PUBMED and Science Direct databases (2014 to 2024), following PRISMA guidelines. Major variables included operative time, fluoroscopy duration, blood loss, postoperative bed rest duration, length of hospital stay, MacNab criteria assessment, Oswestry Disability Index (ODI), visual analog scale (VAS) for pain, and complications. Results: This study included eight comparative studies involving 784 patients with L5- S1 LDH, with 389 undergoing PETD and 395 undergoing PEID. The meta-analysis revealed that PETD was significantly associated with longer operative time (MD, 12.10 min; 95 % CI, 6.41-17.01; P < 0.01), extended fluoroscopy duration (MD, 8.68 times; 95 % CI, 7.14-10.22; P < 0.01), and shorter postoperative bed rest duration (MD,-0.91 days; 95 % CI,-1.75 to-0.07; P = 0.03). No significant differences were observed in blood loss, length of hospital stay, Macnab criteria assessment, VAS scores, ODI scores, or complication rates. Conclusion: PETD demonstrates comparable clinical efficacy and safety to PEID; however, PEID is superior in terms of operative time and fluoroscopy duration, while PETD offers the advantage of reduced postoperative bed rest duration. Our study provides clear insights into the advantages and challenges of each PELD approach for L5- S1 LDH.