The efficacy of minimally invasive versus open lumbar discectomy: A systematic review and meta-analysis

Background: Minimally invasive surgery (MIS) has gained popularity for lumbar discectomy due to its potential for faster recovery and reduced postoperative pain. However, the technique also demands high technical expertise and may carry a greater risk of complications. This systematic review and meta-analysis aimed to compare the outcomes of MIS versus traditional open discectomy in terms of disability, pain, complications, and reoperation rates in patients with lumbar disc herniation. Methods: A comprehensive literature search of MEDLINE and the Cochrane Library was conducted for randomized controlled trials (RCTs) published between January 2005 and January 2022. Fourteen RCTs encompassing 1,447 patients were included. Data were extracted on operative parameters, complications, Oswestry Disability Index (ODI), and Visual Analogue Scale (VAS) scores for leg and back pain. A random-effects model was used to calculate standardized mean differences (SMD) and risk ratios (RR). Results: The meta-analysis showed that MIS significantly improved long-term disability (SMD -0.87) compared to open surgery. However, it did not offer superior relief for leg pain (SMD 0.00) or back pain (SMD -0.59). MIS was associated with slightly higher risks of nerve-root injury (RR 1.18), dural tear (RR 1.65), and reoperation (RR 1.46) compared to open surgery. Infections were less common with MIS (RR 0.24), though the difference was not statistically significant. Conclusion: While MIS may offer improved disability outcomes, its higher complication and reoperation rates suggest that it should not be routinely recommended for lumbar disc herniation treatment. Further high-quality trials are needed.