Full Endoscopic versus Microscopic Lumbar Discectomy for Lumbar Disc Herniation

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.