Skip to main content
SpringerLink
Log in

Microendoscopic discectomy versus open discectomy for lumbar disc herniation: a meta-analysis

European Spine Journal volume 25, pages 1373–1381 (2016)Cite this article

Abstract

Purpose

To compare the outcomes of microendoscopic discectomy and open discectomy for patients with lumbar disc herniation.

Methods

An extensive search of studies was performed in PubMed, Medline, Embase, Cochrane library and Google Scholar. The following outcome measures were extracted: visual analogue scale (VAS), Oswestry disability index (ODI), complication, operation time, blood loss and length of hospital stay. Data analysis was conducted with RevMan 5.0.

Results

Five randomized controlled trials involving 501 patients were included in this meta-analysis. The pooled analysis showed that there was no significant difference in the VAS, ODI or complication between the two groups. However, compared with the open discectomy, the microendoscopic discectomy was associated with less blood loss [WMD = −151.01 (−288.22, −13.80), P = 0.03], shorter length of hospital stay [WMD = −69.33 (−110.39, −28.28), P = 0.0009], and longer operation time [WMD = 18.80 (7.83, 29.76), P = 0.0008].

Conclusions

Microendoscopic discectomy, which requires a demanding learning curve, may be a safe and effective alternative to conventional open discectomy for patients with lumbar disc herniation.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

USD 39.95

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8

References

  1. Kreiner DS, Hwang SW, Easa JE, Resnick DK, Baisden JL, Bess S, Cho CH, DePalma MJ, Dougherty PN, Fernand R, Ghiselli G, Hanna AS, Lamer T, Lisi AJ, Mazanec DJ, Meagher RJ, Nucci RC, Patel RD, Sembrano JN, Sharma AK, Summers JT, Taleghani CK, Tontz WJ, Toton JF (2014) An evidence-based clinical guideline for the diagnosis and treatment of lumbar disc herniation with radiculopathy. Spine J 14:180–191. doi:10.1016/j.spinee.2013.08.003

    Article  PubMed  Google Scholar 

  2. Postacchini F (1999) Management of herniation of the lumbar disc. J Bone Jt Surg Br 81:567–576

    Article  CAS  Google Scholar 

  3. Maroon JC (2002) Current concepts in minimally invasive discectomy. Neurosurgery 51:S137–S145

    Article  PubMed  Google Scholar 

  4. Blamoutier A (2013) Surgical discectomy for lumbar disc herniation: surgical techniques. Orthop Traumatol Surg Res 99:S187–S196. doi:10.1016/j.otsr.2012.11.005

    Article  CAS  PubMed  Google Scholar 

  5. Gibson JN, Waddell G (2007) Surgical interventions for lumbar disc prolapse: updated Cochrane Review. Spine (Phila Pa 1976) 32:1735–1747. doi:10.1097/BRS.0b013e3180bc2431

    Article  Google Scholar 

  6. Mixter WJ, Barr JS (1934) Rupture of the intervertebral disc with involvement of the spinal canal. N Engl J Med 211:210–215

    Article  Google Scholar 

  7. Bokov A, Isrelov A, Skorodumov A, Aleynik A, Simonov A, Mlyavykh S (2011) An analysis of reasons for failed back surgery syndrome and partial results after different types of surgical lumbar nerve root decompression. Pain Phys 14:545–557

    Google Scholar 

  8. Fritsch EW, Heisel J, Rupp S (1996) The failed back surgery syndrome: reasons, intraoperative findings, and long-term results: a report of 182 operative treatments. Spine (Phila Pa 1976) 21:626–633

    Article  CAS  Google Scholar 

  9. Hussein M, Abdeldayem A, Mattar MM (2014) Surgical technique and effectiveness of microendoscopic discectomy for large uncontained lumbar disc herniations: a prospective, randomized, controlled study with 8 years of follow-up. Eur Spine J 23:1992–1999. doi:10.1007/s00586-014-3296-9

    Article  PubMed  Google Scholar 

  10. Salenius P, Laurent LE (1977) Results of operative treatment of lumbar disc herniation: a survey of 886 patients. Acta Orthop 48:630–634

    Article  CAS  Google Scholar 

  11. Foley KT (1997) Microendoscopic discectomy. Tech Neurosurg 3:301–307

    Google Scholar 

  12. Jhala A, Mistry M (2010) Endoscopic lumbar discectomy: experience of first 100 cases. Indian J Orthop 44:184–190. doi:10.4103/0019-5413.62051

    Article  PubMed  PubMed Central  Google Scholar 

  13. Schick U, Dohnert J, Richter A, Konig A, Vitzthum HE (2002) Microendoscopic lumbar discectomy versus open surgery: an intraoperative EMG study. Eur Spine J 11:20–26

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Muramatsu K, Hachiya Y, Morita C (2001) Postoperative magnetic resonance imaging of lumbar disc herniation: comparison of microendoscopic discectomy and Love’s method. Spine (Phila Pa 1976) 26:1599–1605

    Article  CAS  Google Scholar 

  15. Ruetten S, Komp M, Merk H, Godolias G (2008) Full-endoscopic interlaminar and transforaminal lumbar discectomy versus conventional microsurgical technique: a prospective, randomized, controlled study. Spine (Phila Pa 1976) 33:931–939. doi:10.1097/BRS.0b013e31816c8af7

    Article  Google Scholar 

  16. Nakagawa H, Kamimura M, Uchiyama S, Takahara K, Itsubo T, Miyasaka T (2003) Microendoscopic discectomy (MED) for lumbar disc prolapse. J Clin Neurosci 10:231–235

    Article  PubMed  Google Scholar 

  17. Arts MP, Brand R, van den Akker ME, Koes BW, Bartels RH, Tan WF, Peul WC (2011) Tubular diskectomy vs conventional microdiskectomy for the treatment of lumbar disk herniation: 2-year results of a double-blind randomized controlled trial. Neurosurgery 69(135–144):144. doi:10.1227/NEU.0b013e318214a98c

    Google Scholar 

  18. Arts M, Brand R, van der Kallen B, Lycklama ANG, Peul W (2011) Does minimally invasive lumbar disc surgery result in less muscle injury than conventional surgery? A randomized controlled trial. Eur Spine J 20:51–57. doi:10.1007/s00586-010-1482-y

    Article  PubMed  PubMed Central  Google Scholar 

  19. Garg B, Nagraja UB, Jayaswal A (2011) Microendoscopic versus open discectomy for lumbar disc herniation: a prospective randomised study. J Orthop Surg (Hong Kong) 19:30–34

    Google Scholar 

  20. Huang TJ, Hsu RW, Li YY, Cheng CC (2005) Less systemic cytokine response in patients following microendoscopic versus open lumbar discectomy. J Orthop Res 23:406–411. doi:10.1016/j.orthres.2004.08.010

    Article  CAS  PubMed  Google Scholar 

  21. Righesso O, Falavigna A, Avanzi O (2007) Comparison of open discectomy with microendoscopic discectomy in lumbar disc herniations: results of a randomized controlled trial. Neurosurgery 61(545–549):549. doi:10.1227/01.NEU.0000290901.00320.F5

    Google Scholar 

  22. Teli M, Lovi A, Brayda-Bruno M, Zagra A, Corriero A, Giudici F, Minoia L (2010) Higher risk of dural tears and recurrent herniation with lumbar micro-endoscopic discectomy. Eur Spine J 19:443–450. doi:10.1007/s00586-010-1290-4

    Article  PubMed  PubMed Central  Google Scholar 

  23. Furlan AD, Pennick V, Bombardier C, van Tulder M (2009) 2009 updated method guidelines for systematic reviews in the Cochrane Back Review Group. Spine 34:1929–1941

    Article  PubMed  Google Scholar 

  24. Lee SH, Chung SE, Ahn Y, Kim TH, Park JY, Shin SW (2006) Comparative radiologic evaluation of percutaneous endoscopic lumbar discectomy and open microdiscectomy: a matched cohort analysis. Mt Sinai J Med 73:795–801

    PubMed  Google Scholar 

  25. Pan L, Zhang P, Yin Q (2014) Comparison of tissue damages caused by endoscopic lumbar discectomy and traditional lumbar discectomy: a randomised controlled trial. Int J Surg 12:534–537. doi:10.1016/j.ijsu.2014.02.015

    Article  PubMed  Google Scholar 

  26. Mayer HM, Brock M (1993) Percutaneous endoscopic discectomy: surgical technique and preliminary results compared to microsurgical discectomy. J Neurosurg 78:216–225. doi:10.3171/jns.1993.78.2.0216

    Article  CAS  PubMed  Google Scholar 

  27. Xiao SW, Jiang H, Yang LJ, Xiao ZM (2015) Comparison of unilateral versus bilateral pedicle screw fixation with cage fusion in degenerative lumbar diseases: a meta-analysis. Eur Spine J 24:764–774. doi:10.1007/s00586-014-3717-9

    Article  PubMed  Google Scholar 

  28. Schizas C, Tsiridis E, Saksena J (2005) Microendoscopic discectomy compared with standard microsurgical discectomy for treatment of uncontained or large contained disc herniations. Neurosurgery 57(357–360):357–360

    PubMed  Google Scholar 

  29. Ahn Y, Lee HY, Lee S, Lee JH (2011) Dural tears in percutaneous endoscopic lumbar discectomy. Eur Spine J 20:58–64

    Article  PubMed  PubMed Central  Google Scholar 

  30. Khazim R, Dannawi Z, Spacey K, Khazim M, Lennon S, Reda A, Zaidan A (2015) Incidence and treatment of delayed symptoms of CSF leak following lumbar spinal surgery. Eur Spine J. doi:10.1007/s00586-015-3830-4

    PubMed  Google Scholar 

  31. Shriver MF, Xie JJ, Tye EY, Rosenbaum BP, Kshettry VR, Benzel EC, Mroz TE (2015) Lumbar microdiscectomy complication rates: a systematic review and meta-analysis. Neurosurg Focus 39:E6. doi:10.3171/2015.7.FOCUS15281

    Article  PubMed  Google Scholar 

  32. Perez-Cruet MJ, Foley KT, Isaacs RE, Rice-Wyllie L, Wellington R, Smith MM, Fessler RG (2002) Microendoscopic lumbar discectomy: technical note. Neurosurgery 51:S2–S129

    Google Scholar 

  33. Bosacco SJ, Gardner MJ, Guille JT (2001) Evaluation and treatment of dural tears in lumbar spine surgery: a review. Clin Orthop Relat R 389:238–247

    Article  Google Scholar 

  34. Tsutsumimoto T, Yui M, Uehara M, Ohta H, Kosaku H, Misawa H (2014) A prospective study of the incidence and outcomes of incidental dural tears in microendoscopic lumbar decompressive surgery. Bone Jt J 96-B:641–645. doi:10.1302/0301-620X.96B5.32957

    Article  CAS  Google Scholar 

  35. Epstein NE (2013) A review article on the diagnosis and treatment of cerebrospinal fluid fistulas and dural tears occurring during spinal surgery. Surg Neurol Int 4:S301–S317. doi:10.4103/2152-7806.111427

    Article  PubMed  PubMed Central  Google Scholar 

  36. Berjano P, Pejrona M, Damilano M (2013) Microdiscectomy for recurrent L5–S1 disc herniation. Eur Spine J 22:2915–2917

    Article  PubMed  PubMed Central  Google Scholar 

  37. Parker SL, Mendenhall SK, Godil SS, Sivasubramanian P, Cahill K, Ziewacz J, McGirt MJ (2015) Incidence of low back pain after lumbar discectomy for herniated disc and its effect on patient-reported outcomes. Clin Orthop Relat Res 473:1988–1999. doi:10.1007/s11999-015-4193-1

    Article  PubMed  Google Scholar 

  38. Miwa S, Yokogawa A, Kobayashi T, Nishimura T, Igarashi K, Inatani H, Tsuchiya H (2013) Risk factors of recurrent lumbar disc herniation: a single center study and review of the literature. J Spinal Disord Tech. doi:10.1097/BSD.0b013e31828215b3

    PubMed  Google Scholar 

  39. Aizawa T, Ozawa H, Kusakabe T, Nakamura T, Sekiguchi A, Takahashi A, Sasaji T, Tokunaga S, Chiba T, Morozumi N, Koizumi Y, Itoi E (2012) Reoperation for recurrent lumbar disc herniation: a study over a 20-year period in a Japanese population. J Orthop Sci 17:107–113. doi:10.1007/s00776-011-0184-6

    Article  PubMed  Google Scholar 

  40. Cheng J, Wang H, Zheng W, Li C, Wang J, Zhang Z, Huang B, Zhou Y (2013) Reoperation after lumbar disc surgery in two hundred and seven patients. Int Orthop 37:1511–1517

    Article  PubMed  PubMed Central  Google Scholar 

  41. Matsumoto M, Watanabe K, Hosogane N, Tsuji T, Ishii K, Nakamura M, Chiba K, Toyama Y (2013) Recurrence of lumbar disc herniation after microendoscopic discectomy. J Neurol Surg Part A Cent Eur Neurosurg 74:222–227

    Google Scholar 

  42. Wu X, Zhuang S, Mao Z, Chen H (2006) Microendoscopic discectomy for lumbar disc herniation: surgical technique and outcome in 873 consecutive cases. Spine (Phila Pa 1976) 31:2689–2694. doi:10.1097/01.brs.0000244615.43199.07

    Article  Google Scholar 

  43. Chou D, Wang VY, Khan AS (2009) Primary dural repair during minimally invasive microdiscectomy using standard operating room instruments. Neurosurgery 64(356–358):358–359. doi:10.1227/01.NEU.0000338942.11337.DA

    Google Scholar 

  44. van den Akker ME, Arts MP, van den Hout WB, Brand R, Koes BW, Peul WC (2011) Tubular diskectomy vs conventional microdiskectomy for the treatment of lumbar disk-related sciatica: cost utility analysis alongside a double-blind randomized controlled trial. Neurosurgery 69(829–835):835–836. doi:10.1227/NEU.0b013e31822578f6

    Google Scholar 

Download references

Acknowledgments

This work was supported by the Science Foundation of Guangxi (201502). The Manuscript submitted does not contain information about medical device(s)/drug(s). No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

Author information

Author notes

    Authors and Affiliations

    1. Department of Bone and Soft Tissue Neurosurgery, Affiliated Tumor Hospital of Guangxi Medical University, He Di Rd. #71, Nanning, 530021, China

      JuLiang He, ZhenJie Wu & ZhenChao Yuan

    2. Department of Spine and Orthopaedic Surgery, The Red Cross Hospital of Guangxi Wuzhou, Wuzhou, China

      ShanWen Xiao

    Authors
    1. JuLiang He
      View author publications

      You can also search for this author in PubMed Google Scholar

    2. ShanWen Xiao
      View author publications

      You can also search for this author in PubMed Google Scholar

    3. ZhenJie Wu
      View author publications

      You can also search for this author in PubMed Google Scholar

    4. ZhenChao Yuan
      View author publications

      You can also search for this author in PubMed Google Scholar

    Corresponding author

    Correspondence to ZhenChao Yuan.

    Ethics declarations

    Conflict of interest

    None.

    Additional information

    JL. He and SW. Xiao contributed equally to this work.

    Rights and permissions

    Reprints and Permissions

    About this article

    Check for updates. Verify currency and authenticity via CrossMark

    Cite this article

    He, J., Xiao, S., Wu, Z. et al. Microendoscopic discectomy versus open discectomy for lumbar disc herniation: a meta-analysis. Eur Spine J 25, 1373–1381 (2016). https://doi.org/10.1007/s00586-016-4523-3

    Download citation

    • Received:

    • Revised:

    • Accepted:

    • Published:

    • Issue Date:

    • DOI: https://doi.org/10.1007/s00586-016-4523-3

    Keywords

    search

    Navigation