Percutaneous endoscopic lumbar discectomy for LDH via a transforaminal approach versus an interlaminar approach: a meta-analysis

  • Yongjing Huang
  • Jianjian Yin
  • Zhenzhong SunEmail author
  • Sheng SongEmail author
  • Yin Zhuang
  • Xueguang Liu
  • Shihao Du
  • Yongjun Rui



The aim of this study was to systematically compare the safety and effectiveness of percutaneous endoscopic transforaminal discectomy (PETD) versus percutaneous endoscopic interlaminar discectomy (PEID) for the treatment of lumbar disc herniation (LDH).

Material and methods

All studies that were performed to compare PETD with PEID to treat LDH and published until 31 August 2017 were acquired through a comprehensive search in various databases. A meta-analysis was performed using the Cochrane Collaboration’s RevMan 5.3 software.


A total of 13 trials with 974 cases consisting of 3 randomized controlled trials, 3 prospective studies and 7 retrospective studies were included. The results suggest that patients treated with PEID experienced more significant advantages with shorter operation time, less intraoperative blood loss and less intraoperative fluoroscopy times but more complications than those treated with PETD; however, the two operative approaches did not significantly differ in terms of LDH recurrence, hospital stay, Oswestry disability index (ODI) scores, visual analogue scale (VAS) scores, Japanese Orthopaedic Association (JOA) scores and MacNab criteria at the final follow-up.


Based on the results of this study, although PEID may be superior to PETD in certain ways, some of its advantages have yet to be verified and the two interventions were not significantly different in terms of relief of symptoms and functional recovery. Therefore, PEID would be recommended for treating LDH especially at L5/S1 under certain conditions but a prudent attitude is necessary to choose between the two operative approaches before a large sample and high quality randomized controlled trials have been performed.


Comparative study Safety Minimally invasive surgical procedures Fluoroscopy Complications 



Cochrane back review group


Japanese Orthopaedic Association


Lumber disc herniation


Newcastle Ottawa quality assessment scale


Oswestry disability index


Percutaneous endoscopic interlaminar discectomy


Percutaneous endoscopic lumbar discectomy


Percutaneous endoscopic transforaminal discectomy


Risk of bias


Transforaminal endoscopic spine system


Visual analogue scale


Yeung endoscopic spine system

Perkutane endoskopische lumbale Diskektomie bei lumbalem Bandscheibenvorfall mittels transforaminaler vs. interlaminarer Verfahren: eine Metaanalyse



Das Ziel dieser Studie war es, die Sicherheit und Wirksamkeit der perkutanen endoskopischen transforaminalen Diskektomie (PETD) zur Behandlung lumbaler Bandscheibenvorfälle („lumbar disc herniation“, LHD) systematisch zu vergleichen.

Material und Methoden

Alle Studien, die durchgeführt wurden, um die PETD mit der PEID zur Behandlung eines LDH zu vergleichen und bis 31. August 2017 veröffentlicht worden waren, wurden aus einer umfassenden Suche in verschiedenen Datenbanken extrahiert. Eine Metaanalyse wurde mittels Cochrane Collaboration’s RevMan 5.3 software durchgeführt.


Insgesamt wurden 13 Studien mit 974 Fällen, die jeweils 3 randomisierte kontrollierte, 3 prospektive und 7 retrospektive Studien beinhalten, wurden eingeschlossen. Die Ergebnisse zeigen, dass Patienten, die mit PEID behandelt wurden, mehr signifikante Vorteile durch eine kürzere Operationszeit, weniger intraoperativen Blutverlust sowie eine kürzere intraoperative Fluoroskopiedauer zeigten, allerdings auch mehr Komplikationen aufwiesen als Patienten, die mittels PETD behandelt wurden. Jedoch unterschieden sich die beiden Operationsverfahren beim letzten Follow-up nicht signifikant hinsichtlich eines erneuten Auftretens eines LDH, Hospitalisationsdauer, Oswestry-Disability-Index(ODI)-Scores, Scores der visuellen Analogskala (VAS), Japanese-Orthopaedic-Association(JOA)-Scores und MacNab-Kriterien.


Obwohl die PEID der PETD in mancher Hinsicht überlegen sein mag, müssen einige Vorteile auf Grundlage der Ergebnisse dieser Studie noch verifiziert werden. Die beiden Operationsverfahren unterschieden sich nicht signifikant hinsichtlich Symptomlinderung und Wiederherstellung der Funktionsfähigkeit. Daher wäre die PEID zur Behandlung von LDH unter gewissen Umständen insbesondere an L5/S1 zu empfehlen. Jedoch ist die Entscheidung für das ein oder andere Operationsverfahren mit Bedacht zu treffen, bis randomisierte kontrollierte Studien mit größeren Fallzahlen und hoher Qualität durchgeführt wurden.


Vergleichsstudie Sicherheit Minimal-invasive Operationsverfahren Fluoroskopie Komplikationen 


Author contributions

Yongjing Huang and Jianjian Yin wrote the main manuscript text, and YinZhuang, Xueguang Liu and Shihao Du prepared the figures. Zhenzhong Sun, Yongjun Rui and Sheng Song compiled the data.

Compliance with ethical guidelines

Conflict of interest

Y. Huang, J. Yin, Z. Sun, S. Song, Y. Zhuang, X. Liu, S. Du and Y. Rui declare that they have no competing interests.

For this article no studies with human participants or animals were performed by any of the authors. All studies performed were in accordance with the ethical standards indicated in each case.


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Copyright information

© Springer Medizin Verlag GmbH, ein Teil von Springer Nature 2019

Authors and Affiliations

  • Yongjing Huang
    • 1
  • Jianjian Yin
    • 2
  • Zhenzhong Sun
    • 1
    Email author
  • Sheng Song
    • 1
    Email author
  • Yin Zhuang
    • 1
  • Xueguang Liu
    • 1
  • Shihao Du
    • 1
  • Yongjun Rui
    • 1
  1. 1.Department of OrthopedicsWuxi 9th People’s Hospital Affiliated to Soochow UniversityWuxiChina
  2. 2.Department of OrthopedicsThe Affiliated Changzhou No.2 People’s Hospital with Nanjing Medical UniversityChangzhouChina

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