Complications of Full-Endoscopic Lumbar Discectomy versus Open Lumbar Microdiscectomy: A Systematic Review and Meta-Analysis

-OBJECTIVE: Endoscopic lumbar discectomy has been an alternative for treating lumbar disc herniation. Evidence -based study for the benefit zone of full-endoscopic lum-bar discectomy (FELD) is necessary. The study compared the complication risks between the FELD and open dis-cectomy or microdiscectomy.-METHODS: The literature search was from 4 online da-tabases for randomized controlled trials (RCTs) and cohort studies. The meta-analysis of different study designs was conducted separately. Complication rates were considered primary outcomes, and the recurrence and revision rates were considered secondary outcomes.-RESULTS: Six RCTs and thirteen cohort studies met the eligibility criteria. The meta-analysis was conducted sepa-rately. From the pooled RCT meta-analysis, the overall complication rates of FELD and open discectomy/micro-discectomy were 5.5% and 10.4%, respectively. The moderate -quality evidence suggested that FELD had a lower risk of overall complications (risk ratio [RR] = 0.55, 95% confidence interval [CI] = 0.31-0.98). There was no significant difference in specific complications and recurrence. The analysis of cohort studies revealed no significant difference in overall complications, but there was significant heterogeneity in the results. The risk of dural injury was significantly lower for FELD (RR = 0.46, 95% CI = 0.22-0.96). The pooled meta -analysis from cohort studies suggested a higher risk of tran-sient dysesthesia (RR = 3.70, 95% CI = 1.54-8.89), residual fragment (RR = 5.29, 95% CI = 2.67-10.45), and revision surgeries (RR = 1.53, 95% CI = 1.12-2.08) for FELD. -CONCLUSIONS: The current evidence showed a lower risk of overall complications for FELD. The quality of evi-dence was moderate to low, and the risk of bias from the primary literature should be concerned.