Minimally invasive surgery for lumbar disc herniation: a meta-analysis of efficacy and safety

OBJECTIVE: Minimally invasive treatment plays a pivotal role in the management of lumbar disc herniation (LDH). Owing to its benefits, including reduced trauma, accelerated recovery, and decreased incidence of complications, it has progressively emerged as the primary approach for treating this condition. The objective of this study was to compare the outcomes observed in patients who underwent various minimally invasive surgical techniques for the treatment of LDH. STUDY DESIGN: Systematic reviews and meta-analyses. METHODS: A systematic review was conducted to evaluate and compare the effectiveness of various minimally invasive treatment options for LDH, including percutaneous transforaminal endoscopic discectomy (PTED), microendoscopic discectomy (MED), microscopic discectomy (MD), percutaneous endoscopic interlaminar discectomy (PEID), endoscopic discectomy (ED), full-endoscopic discectomy (FED), percutaneous endoscopic lumbar discectomy (PELD), and PELD combined with platelet-rich plasma (PRP). The outcomes assessed included visual analog scores (VAS) for leg pain and back pain, Japanese Orthopedic Association scores, the Oswestry Disability Index (ODI), 36 physical functioning and bodily pain scores, the EuroQol five-dimensional score, the numeric pain score, the duration of surgery, and the relative risk of reoperation. The collected data were analyzed via a random effects meta-analysis approach. RESULTS: This review analyzed 22 comparative studies with 4068 patients. Compared to MED, PTED had a shorter operative time (64.19 minutes vs. MED's 66.61 minutes; not significant), less intraoperative blood loss (16.97 vs. 28.55; P < 0.001), and a shorter hospital stay (4.92 days vs. 6.71 days; P < 0.001). MED was associated with a lower postoperative recurrence rate (3.69% vs. 6.08% for PTED). Compared with PTED, PEID was associated with lower ODI (12.69 vs. 15.39; P = 0.77) and VAS scores (1.38 vs. 1.46; P = 0.42). MD significantly decreased intraoperative blood loss (48.63 vs. 64.4 in the ED) and operative time (85.38 vs. 114.65). The combination of PELD and PRP injections provided pain relief and reduced recurrence. CONCLUSION: Different minimally invasive surgeries for LDH have unique benefits. PTED has advantages in terms of operative time, blood loss, and length of hospital stay. However, there is a risk of nerve damage and cerebrospinal fluid leakage. The recurrence rate of MED is low. PEID is associated with lower ODI and VAS scores. MD reduces blood loss and operative time. The combination of PELD and PRP injections provides a new therapeutic direction for the treatment of LDH by relieving pain, reducing recurrence, improving patient satisfaction, and possibly promoting disc repair.