Percutaneous transforaminal endoscopic discectomy versus microendoscopic discectomy for lumbar disc herniation: a systematic review and meta-analysis

Background: Several studies have compared the efficacy and safety of percutaneous transforaminal endoscopic discectomy (PTED) with microendoscopic discectomy (MED) in treating lumbar disc herniation (LDH), however, with contradictory results. This systematic review and meta-analysis aimed to compare the effectiveness and safety between PTED and MED in addressing LDH. Methods: A comprehensive literature review was conducted in four common databases. All the clinical studies focusing on the comparison between PTED and MED for LDH were evaluated. Meta-analyses of clinical variables were performed. Results: A total of 5 studies involving 500 LDH patients were included into this study. There were 254 patients in PTED group and 246 patients in MED group. PTED was significantly related to smaller length of incision (MD=-1.02 cm, 95% CI=-1.21-0.83 cm, P<0.01), less blood loss (MD=-15.46 ml, 95% CI=-22.76-8.16 ml, P<0.01), shorter postoperative in- bed time (MD=-58.74 hours, 95% CI=-99.21-18.27, P<0.01) and length of hospital stay (MD=-1.27 days, 95% CI=-2.07-0.47, P<0.01) when compared to MED. However, increased radiation exposure was detected in PTED group (MD=10.00 seconds, 95% CI=7.67-12.33 seconds, P<0.01). Additionally, there were no obvious differences between two groups in operative time (P=0.47) or satisfaction rate (P=0.53). As for patient-reported outcomes, no obvious differences were observed between PTED and MED in Visual Analogue Scale (VAS), VAS of back pain (VAS-BP), VAS of leg pain (VAS-LG), Japanese Orthopedic Association Scores (JOA) or Oswestry Disability Index (ODI). Conclusion: PTED and MED were both sufficient and safe in addressing LDH. PTED was superior to MED in length of incision, blood loss, postoperative in-bed time, and length of hospital stay. However, PTED was distinctly associated with increased radiation exposure compared to MED.