Percutaneous Endoscopic Lumbar Discectomy for L5S1 Lumbar Disc Herniation Using a Transforaminal Approach Versus an Interlaminar Approach: A Systematic Review and Meta-Analysis

BACKGROUND: Several studies have compared the clinical efficacy of percutaneous endoscopic lumbar discectomy for L5-S1 lumbar disc herniation (LDH) using a transforaminal approach with an interlaminar approach, but with contradictory results. The aim of this study was to explore the comparison of efficacy and safety between percutaneous endoscopic transforaminal discectomy (PETD) and percutaneous endoscopic interlaminar discectomy (PEID) for L5-S1 LDH. METHODS: Six common databases were comprehensively searched, and relevant studies were included into the analysis when they met all the inclusion criteria. RESULTS: Nine studies involving 621 patients were included into the study. The results indicated that PETD was significantly associated with greater fluoroscopy times (mean difference [MD], 9.28 times; 95% confidence interval [CI], 6.84-11.71; P < 0.01) and longer operative time (MD, 16.51 minutes; 95% CI, 4.01-29.02; P=0.01) compared with PEID. However, there were no distinct differences between PETD and PEID in estimated blood loss (P=0.24), bed time after surgery (P=0.32), hospitalization time (P=0.27), or MacNab evaluation (P=0.78). Similarly, no obvious differences were detected between PETD and PEID regarding Visual Analogue Scale score, Japanese Orthopedic Association (JOA) score, or Oswestry Disability Index (ODI) when measured preoperatively, 1 day postoperatively, 3 months postoperatively, or at the last follow up. In addition, no significant difference was found regarding overall incidence of complications between PETD and PEID (P=0.14). Nevertheless, a significantly lower incidence rate of dural tear was observed in PETD compared with PEID (P=0.04). CONCLUSIONS: PETD had comparable clinical efficacy and safety compared with PEID; however, PEID was superior to PETD regarding fluoroscopy times and operative time. Therefore, PEID might be a better surgical procedure for L5S1 LDH.