Endoscopic Microdiscectomy in Athletes: A Systematic Review and Meta-analysis

Introduction: Athletes are at increased risk of lumbar disc herniation due to degenerative and traumatic factors. Prior studies have evaluated the efficacy of traditional open discectomy in athletes; however, there is limited evidence regarding the utility of endoscopic discectomy for athletes recovering from lumbar disc herniations. Our objective is to evaluate the efficacy of endoscopic discectomy in athletes with lumbar disc herniation, focusing on return to play and pain outcomes.

Methods: Studies included athletes with lumbar disc herniation who underwent endoscopic discectomy. Case reports and case series with fewer than 10 patients were excluded. PubMed-Medline and Ovid-Medline databases were searched, with the last search conducted in May 2024. Risk of bias was assessed using the Methodological Index for Non-Randomized Studies (MINORS) tool for non-comparative studies. Data were synthesized using a random effects model. Meta-analyses were conducted using the R software version 4.3.0.

Results: Four studies with a total of 119 athletes were included. The combined return to play rate was 96% (95% CI: 90%-100%), with a mean return to play time of 8.25 weeks (95% CI: 6.51-10.46 weeks). The mean differences in leg and back VAS were -68.83 (95% CI: -102.05 to -35.61) and -68.42 (95% CI: -101.45 to -35.40), respectively.

Conclusion : Endoscopic discectomy in athletes is associated with high return to play rates and significant reductions in pain. Future studies that stratify outcomes based on the level of competition and specific endoscopic discectomy technique are needed to fully assess the utility of endoscopic discectomy in athletes.