Percutaneous Transforaminal Endoscopic Discectomy versus Micro-Endoscopic Discectomy for Lumbar Disc Herniation

BACKGROUND: Percutaneous transforaminal endoscopic discectomy (PTED) and micro-endoscopic discectomy (MED) are alternative minimally invasive, widely performed procedures for the treatment of lumbar disc herniation (LDH). This study compared the clinical outcomes of these 2 surgical techniques in treating LDH. MATERIAL/METHODS: A comprehensive literature search was performed in PubMed, MEDLINE, EMBASE, Cochrane, and Google Scholar to identify all relevant studies comparing PTED and MED in treating LDH. RESULTS: Eight comparative studies assessing a total of 805 patients were included for the final analysis. The results indicated that PTED needs a shorter incision [−1.02 (−1.21 to −0.83), p<0.001], less time in bed [−2.14 (−3.34 to −0.94), p<0.001], and shorter hospital stay [−1.92 (−2.90 to −0.94), p<0.001], whereas MED is superior regarding intraoperative fluoroscopy [7.47 (2.78 to 12.17), p=0.002] and total cost [0.69 (0.38 to 1.00), p<0.001]. No significant differences were found on operation time, intraoperative blood loss, or complications. Significant lower back pain was found in the PTED group at 1 week postoperatively [−0.52 (−0.95 to −0.10), p=0.02] and 1 year postoperatively or the last follow-up [−0.41 (−0.76 to −0.06), p=0.02]; significant lower leg pain was also detected at 1 week postoperatively [−0.52 (−0.75 to −0.30), p<0.001]. Oswestry Disability Index (ODI) was significant better at 1 week postoperatively in the PTED group [−4.41 (−7.03 to −1.79), p=0.001]. No significant differences were detected at other time points regarding pain score and ODI. CONCLUSIONS: Both PTED and MED are safe and effective techniques for treating LDH. However, taking all clinical outcomes together, PTED might be a preferable treatment modality for LDH.