medical student UCLA Mountain House, California, United States
Introduction: Lumbar disc herniation (LDH) is a common cause of back and leg pain. L5-S1 LDH is usually treated with a microdiscetomy (MD). However, with the introduction of endoscopic techniques, it is unclear which patients would benefit the most from endoscopic discectomy (ED).
Methods: We systematically searched PubMed, Embase, and Cochrane Central for studies comparing patients who underwent L5-S1 LDH repair with MD or ED. Postoperative pain was evaluated using the visual analog scale (VAS) and quality of life with Oswestry Disability Index (ODI). Mean differences (MDs) and odds ratio (OR) were pooled using a random-effects model.
Results: We screened 3,506 articles and included 4 studies with 264 patients, of whom 134 (51%) underwent MD and 130 (49%) were treated with ED. ED was associated with reduced back pain at 1 month (MD=-0.59, 95% CI [-1.06,-0.11], I²=0%). However, no significant differences were noted in leg pain at 1 month (MD=0.16, 95% CI [-0.78, 1.10], I²=0%), 6 months (MD=0.23, 95% CI [-0.76, 1.22], I²=0%) and 12 months (MD=0.17, 95% CI [-0.81, 1.15], I²=0), back pain at 6 months (MD=-0.29, 95% CI [-0.79, 0.20], I²=0%) and 12 months (MD=-0.22, 95% CI [-0.71, 0.28], I²=0%), operative time (MD=2.45, 95% CI [-31.09, 63.74], p=0.89, I²=92%), or recurrence (OD=0.85, 95% CI [0.22, 3.35], I²=0%).
Conclusion : No significant differences were found between ED and MD for treating L5-S1 LDH regarding clinical outcomes. While ED may offer a less invasive option and reduce early postoperative pain, further trials are needed to evaluate the long-term benefits, especially in minimizing post-operative pain and improving recovery.
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