Spine - 2026-06-18 - Journal Article
Full Endoscopic versus Microscopic Lumbar Discectomy for Lumbar Disc Herniation: A Meta-analysis of Randomized-controlled Trials.
Patel S, Nischal SA, Kale KM, Dubb A, Sarikonda A, Quraishi D, Hines K, Jallo J, Harrop JS, Prasad SK
Topics
Key Takeaway
Full endoscopic discectomy reduces return-to-work time by 22.68 days and wound-related complications (infection RR 0.30, hematoma RR 0.47) versus microscopic discectomy, but increases fluoroscopic radiation exposure (MD +0.92 units) with no consistent long-term superiority in pain or ODI.
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Summary
This meta-analysis of 17 RCTs compared full endoscopic discectomy (FED) versus microscopic discectomy (MSD) for lumbar disc herniation across safety, recovery, and PROM endpoints. FED demonstrated statistically significant reductions in blood loss (38.62 mL), return-to-work time (22.68 days), postoperative infection (RR 0.30), poor wound healing (RR 0.25), and hematoma (RR 0.47), with a marginal back VAS benefit at 1 year (MD -0.18) and ODI benefit at 2 years (MD -5.72). Leg pain trajectories, operative time, and length of stay were equivalent, and FED carried greater fluoroscopic radiation exposure.
Key Limitation
The 2-year ODI benefit (MD -5.72, just exceeding the 12.8-point MCID threshold only at the confidence interval boundary) is of uncertain clinical significance and is derived from a subset of trials, making its reliability across the full cohort unclear.
Original Abstract
STUDY DESIGN
Systematic review and meta-analysis.
OBJECTIVE
To compare safety, recovery metrics, and patient-reported outcomes between full endoscopic discectomy (FED) and microscopic discectomy (MSD) for lumbar disc herniation (LDH).
SUMMARY OF BACKGROUND DATA
Full-endoscopic techniques aim to reduce access-related soft tissue injury compared with conventional MSD but rely on fluoroscopic guidance and constrained working corridors. Prior syntheses frequently pooled heterogeneous minimally invasive approaches or non-randomized studies, limiting interpretability for contemporary practice.
METHODS
PubMed, Embase, and CENTRAL were searched from inception to 16 February 2026 for randomized controlled trials comparing FED with MSD in adults with LDH. Prespecified outcomes included complications, Visual Analog Scale (VAS) back and leg pain, Oswestry Disability Index (ODI), and perioperative/recovery measures. Random-effects meta-analyses were performed throughout. Risk of bias (RoB 2) and certainty of evidence (GRADE) were assessed.
RESULTS
Seventeen trials including 2238 patients (FED 1070; MSD 1168) were analyzed (mean follow-up 14.6-14.7 mo). Leg pain trajectories were comparable. Back VAS favored FED at 1 year (MD -0.18; 95% CI: -0.35--0.01) and ODI at 2 years (MD -5.72; 95% CI: -11.24--0.21). FED reduced blood loss (MD -38.62 mL; 95% CI: -67.69--9.54) and return-to-work time (MD -22.68 d; 95% CI: -32.85--12.50), but increased radiation exposure (MD 0.92; 95% CI: 0.84-1.00). Operative time and length of stay were similar. FED lowered postoperative infection (RR 0.30; 95% CI: 0.12-0.78), poor wound healing (RR 0.25, 95% CI: 0.07-0.96), and hematoma (RR 0.47; 95% CI: 0.23-0.94). Other non-wound-related complications did not differ. Risk of bias was low-to-moderate; certainty of evidence was moderate.
CONCLUSION
FED and MSD provide comparable decompressive efficacy and patient-reported outcomes. FED reduces wound-related morbidity and may accelerate return to work, at the cost of greater fluoroscopic exposure, without consistent long-term superiority in pain or disability.