European Spine Journal

, Volume 22, Issue 11, pp 2458–2465 | Cite as

Systematic review of microendoscopic discectomy for lumbar disc herniation

  • Nick SmithEmail author
  • James Masters
  • Cyrus Jensen
  • Almas Khan
  • Andrew Sprowson
Review Article


Study design

Systematic review.


To search and analyse randomised controlled trials (RCTs) published since the Cochrane review by Gibson and Waddell (2007) comparing microendoscopic discectomy (MED) with open discectomy (OD) or microdiscectomy (MD) and to assess whether MED improves patient-reported outcomes.

Summary of background

Discectomy for symptomatic herniated lumbar discs is an effective operative treatment. A number of operative techniques exist including OD, MD, and MED. A 2007 Cochrane review identified OD as an effective treatment for symptom improvement, and found sufficient evidence for MD. However, evidence for MED was lacking.


A systematic review of Medline and Embase was carried out. Aiming to identify RCTs carried out after 2007, which compared OD with MD and MED which reported the Oswestry disability index (ODI) as an outcome.


Four RCTs were identified. None of the studies found a significant difference in the ODI scores between study groups at any time point. Three studies compared MED to OD and one compared OD, MD, and MED. The largest study reported an increased number of severe complications in the MED group.


There is some evidence to suggest that MED performed by surgeons skilled in the technique in tertiary referral centres is as effective as OD.


Microendoscopic discectomy Lumbar disc herniation Sciatica Discectomy 


Conflict of interest



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Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • Nick Smith
    • 1
    Email author
  • James Masters
    • 1
  • Cyrus Jensen
    • 2
  • Almas Khan
    • 3
  • Andrew Sprowson
    • 1
  1. 1.Department of Trauma and OrthopaedicsUniversity Hospitals Coventry and WarwickshireCoventryUK
  2. 2.Department of Trauma and OrthopaedicsNorthern DeaneryNewcastle upon TyneUK
  3. 3.Leeds General InfirmaryLeedsUK

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