Percutaneous transforaminal endoscopic discectomy in patients with lumbar disc herniation: a meta-analysis

Background: In lumbar disc herniation (LDH), the soft inner material of the spinal disc migrates through the annulus fibrosus, resulting in compression of nerve roots and causing lower back and leg pain. Surgical interventions for LDH include microendoscopic discectomy (MED), percutaneous transforaminal endoscopic discectomy (PTED), percutaneous endoscopic interlaminar discectomy (PEID), and traditional open discectomy (OD). Method: Electronic databases, including PubMed, Cochrane Library, Embase, Web of Science (WOS), and Scopus, were searched to include randomised controlled trials (RCTs) which compared PTED with PEID, MED, or OD. The primary outcome measures were surgery duration and pain relief. Data from eligible studies were extracted, and the risk of bias in the included studies was assessed using the Cochrane Risk of Bias-2 tool. Statistical analyses were performed using RevMan 5.4 software, and sensitivity and subgroup analyses were conducted based on the type of surgical intervention and follow-up duration. Results: Twelve studies with 1490 patients were included. There was no significant difference between PTED and other groups regarding surgery duration. Also, there was no significant difference between PTED and OD in pain relief except relieving pain after 2 years [MD = − 0.72, 95%CI (− 1.33, − 0.10), p = 0.02)]. Compared to OD, PTED had a significantly lower complications rate [RR = 0.19, 95%CI (0.12, 0.31), p < 0.00001], Conclusion: PTED was associated with a shorter hospital stay and fewer complications than OD. There was also no significant difference between PTED and PEID regarding surgery duration, pain relief, or impact on daily activities. PTED was associated with fewer complications and a shorter hospital stay.