Patient-reported functional outcomes of endoscopic lumbar microdiscectomy: A non-inferiority meta-analysis

Lumbar Disc Herniation (LDH) is a condition characterized by the displacement of intervertebral disc material and represents the most common cause of radiculopathy. Conservative treatment for LDH focuses on lifestyle changes and pharmacologic interventions to manage symptoms. Surgery for LDH is indicated when conservative treatment fails, particularly in cases of progressive or persistent neurological deficits and debilitating back or leg pain. Currently, open discectomy and microdiscectomy are the most common treatment methods used today for surgical management of LDH. Literature has yet to establish meaningful differences in functional outcome between the two modalities. The objective of this study is to describe the efficacy of endoscopic microdiscectomy compared to open microdiscectomy as measured by patient-reported functionality outcomes. A literature search was performed using the PubMed and Scopus databases for randomized control trials using the Oswestry Disability Index (ODI) and Visual Analogue Scales (VAS) for leg and back pain for lumbar disc herniation surgery at 12 months post-operative via endoscopic or microscopic approaches. Ten studies were included in the meta -analysis. The estimated coefficients for ODI (−0.201, p = 0.065), as well as VAS back (−0.037, p = 0.615) and VAS leg (−0.022, p = 0.805) indicate no significant relationship between surgical approach and patient-reported functional outcome at 12 months post-operative. Endoscopic microdiscectomy is an alternative to traditional open and microscopic techniques, demonstrating non-inferiority in functionality and pain outcomes for patients with lumbar disc herniation.