Percutaneous Transforaminal Endoscopic Discectomy versus Micro-Endoscopic Discectomy for Lumbar Disc Herniation

Background: Percutaneous transforaminal endoscopic discectomy (PTED) and micro-endoscopic discectomy (MED) are al- ternative minimally invasive, widely performed procedures for the treatment of lumbar disc herniation (LDH). This study compared the clinical outcomes of these 2 surgical techniques in treating LDH. Material/Methods: A comprehensive literature search was performed in PubMed, MEDLINE, EMBASE, Cochrane, and Google Scholar to identify all relevant studies comparing PTED and MED in treating LDH. Results: Eight comparative studies assessing a total of 805 patients were included for the final analysis. The results in- dicated that PTED needs a shorter incision [-1.02 (-1.21 to -0.83), p<0.001], less time in bed [-2.14 (-3.34 to -0.94), p<0.001], and shorter hospital stay [-1.92 (-2.90 to -0.94), p<0.001], whereas MED is superior regarding intraoperative fluoroscopy [7.47 (2.78 to 12.17), p=0.002] and total cost [0.69 (0.38 to 1.00), p<0.001]. No significant differences were found on operation time, intraoperative blood loss, or complications. Significant lower back pain was found in the PTED group at 1 week postoperatively [-0.52 (-0.95 to -0.10), p=0.02] and 1 year postoperatively or the last follow-up [-0.41 (-0.76 to -0.06), p=0.02]; significant lower leg pain was also detected at 1 week postoperatively [-0.52 (-0.75 to -0.30), p<0.001]. Oswestry Disability Index (ODI) was significant better at 1 week postoperatively in the PTED group [-4.41 (-7.03 to -1.79), p=0.001]. No significant differences were detected at other time points regarding pain score and ODI. Conclusions: Both PTED and MED are safe and effective techniques for treating LDH. However, taking all clinical outcomes together, PTED might be a preferable treatment modality for LDH.