Minimum 2-year Efficacy of Percutaneous Endoscopic Lumbar Discectomy Versus Microendoscopic Discectomy: a Meta-analysis

Abstract Introduction Minimally invasive surgery in the treatment of lumbar disc herniation has gained popularity in recent years. As two dominant techniques, percutaneous endoscopic lumbar discectomy (PELD) and microendoscopic discectomy (MED) obtained comparable short-term clinical outcomes. However, the mid-and-long term efficacy and re-operative rate are still in debate. Methods An electronic retrieval from Web of Science, PubMed, Scopus, Cochrane Library, EMBASE, Ovid and EBSCO was performed. STATA 14.0 was used for statistical analysis. Odds ratio (OR) and 95% confidence interval (CI) were pooled to quantify the strength of the statistical differences. Results A total of 9 studies (468 patients in the PELD group and 516 patients in the MED group) with high methodological quality met the selection criteria. No differences were found in leg pain VAS score before surgery and at any follow-up time after surgery. PELD obtained better outcomes in low back pain VAS score, ODI score and excellent and good ratio after 24 months postoperatively (OR=-0.856, 95% CI: -1.488 to -0.224, P=0.008; OR=-0.425, 95% CI: -0.724 to -0.127, P=0.005; OR=3.034; 95% CI: 1.254 to 7.343; P=0.014) compared with MED, while no difference was found within 24 months postoperatively. No significant differences were found in complication, recurrence and reoperation rates within and after 2 years postoperatively. Conclusion Both PELD and MED can offer relatively effective and safe treatment for the low back pain and radiculopathy associated with a herniated disc. And PELD could obtain better mid-and-long term clinical outcomes compared with MED.