Beyond the Microscope: Is Endoscopic Discectomy the Next Gold Standard for Lumbar Disc Herniation?
Issued Date
2026-01-01
Resource Type
ISSN
25866583
eISSN
25866591
Scopus ID
2-s2.0-105029290376
Journal Title
Neurospine
Volume
23
Issue
1
Start Page
61
End Page
79
Rights Holder(s)
SCOPUS
Bibliographic Citation
Neurospine Vol.23 No.1 (2026) , 61-79
Suggested Citation
Santipas B., Kim J.S., Mekariya K., Choi J.Y.S., Cho S.K. Beyond the Microscope: Is Endoscopic Discectomy the Next Gold Standard for Lumbar Disc Herniation?. Neurospine Vol.23 No.1 (2026) , 61-79. 79. doi:10.14245/ns.2551450.725 Retrieved from: https://repository.li.mahidol.ac.th/handle/123456789/114995
Title
Beyond the Microscope: Is Endoscopic Discectomy the Next Gold Standard for Lumbar Disc Herniation?
Author(s)
Corresponding Author(s)
Other Contributor(s)
Abstract
Objective: This systematic review and meta-analysis aimed to compare endoscopic discectomy (ED) with microdiscectomy (MD) for lumbar disc herniation, evaluating patient-reported outcomes, perioperative parameters, and complications to determine if ED could replace MD as the gold standard. Methods: Following PRISMA (Preferred Reporting Items for Systematic Reviews and Metaanalyses) guidelines, we searched PubMed, Embase, Scopus, and Web of Science (January 2000–June 2025) for randomized controlled trials (RCTs) and prospective cohort studies comparing MD with ED subtypes (transforaminal endoscopic lumbar discectomy [TELD], interlaminar endoscopic lumbar discectomy [IELD], and unilateral biportal endoscopy [UBE]). Outcomes included Oswestry Disability Index (ODI), visual analogue scale (VAS) for pain, operative time, hospital stay, complications, and recurrence. Pooled mean differences and odds ratios (ORs) were calculated using random-effects models, with subgroup analyses by ED subtype. Risk of bias was assessed using RoB 2.0 and ROBINS-I tools. Results: Seventeen studies (9 RCTs, 8 cohorts; n = 3,115) were included. ED significantly reduced hospital stay (mean difference,-2.43 days; 95% CI,-3.62 to-1.23; p < 0.05) and showed greater short-term ODI improvement (mean difference, 2.13; 95% CI, 0.58–3.67). No differences were observed in operative time, long-term ODI, or VAS scores. ED had lower wound complications but a higher recurrence risk with TELD (OR, ~2.0). High heterogeneity (I² > 95%) and limited long-term data (> 2 years) were noted. Conclusion: ED offers perioperative advantages and comparable efficacy but does not surpass MD due to TELD’s increased recurrence risk. IELD and UBE are promising alternatives, but MD remains the benchmark. Long-term RCTs are needed.