What question did this study set out to answer?

The aim is to compare endoscopic discectomy with microdiscectomy in terms of outcomes and complications for lumbar disc herniation.

February 2, 2026Open Access

Beyond the Microscope: Is Endoscopic Discectomy the Next Gold Standard for Lumbar Disc Herniation?

Key Points

The aim is to compare endoscopic discectomy with microdiscectomy in terms of outcomes and complications for lumbar disc herniation.
Conducted a systematic review and meta-analysis following PRISMA guidelines.
Searched multiple databases for relevant randomized controlled trials and prospective cohort studies.
Compared patient outcomes such as Oswestry Disability Index and visual analogue scale scores, along with perioperative parameters.
Endoscopic discectomy significantly reduced hospital stay by an average of 2.43 days.
Showed greater short-term improvement in Oswestry Disability Index by an average of 2.13 points.
No significant differences in operative time or long-term outcomes between the two methods.
Endoscopic discectomy had a heightened recurrence risk, particularly with transforaminal endoscopic procedures.

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 Meta-analyses) 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; p95%) 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.

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