Full-Endoscopic Procedures Versus Traditional Discectomy Surgery for Discectomy: A Systematic Review and Meta-analysis of Current Global Clinical Trials

Background: Traditional discectomy surgery (TDS) provides good or excellent results in clinicalsurgical discectomy but may induce neural adhesion, spinal structural damage, instability, andother complications. The potential advantages of full-endoscopic (FE) procedures over standardTDS include less blood loss, less postoperative pain, shorter hospitalization, and an earlier return towork. However, more evidence is needed to support this new technology in clinical applications.Objective: The aim of this systematic review and meta-analysis was to compare the safety andefficacy of FE and TDS.Study Design: Comprehensive systematic review and meta-analysis of the literature.Methods: Electronic databases, including PubMed, EMBASE, SinoMed, and Cochrane Library,were searched to identify clinical therapeutic trials comparing FE to TDS for discectomy.Results: Six trials comprising 730 patients were included, and the overall quality of the literaturewas moderate, including 4 Grade I levels of evidence (4 randomized controlled trials, [RCTs]) and 2Grade II levels (2 non-RCTs). The pooled data revealed no difference in reoperation rates between FEand TDS (P = 0.94), but the complication rate was significantly lower in the FE group (3.86%) thanin the TDS group (11.4%). Perioperative parameters (operation time, blood loss, hospitalizationtime, and return to work days) were significantly lower in the FE group (P < 0.05 for all groupsusing either score). Postoperative pain and neurology score assessments were conducted at 4different time points at 3 months, 6 months, 12 months, and 24 months. Significant differenceswere detected in the following: lumbar North American Spine Society (NASS) pain at 6 months (P= 0.008); cervical NASS neurology at 6 months (P = 0.03); visual analog scale (VAS) score in leg at3 months (P < 0.001); VAS score in arm at 24 months (P = 0.002); VAS score in neck at 3 months,6 months, and 12 months after therapy (P = 0.003, P = 0.004, P = 0.01); and VAS score in neck at3 months and 6 months (P = 0.01, P = 0.004). Moreover, the pooled data revealed no statisticallysignificant differences in improvements in the Oswestry disability index (ODI), instability (X-ray),and Hilibrand criteria (P > 0.05 for all groups).Limitations: Only 6 studies were included, 4 of which had the same authors. Between-studyheterogeneity due to differences in socioeconomic factors, nutrition, and matching criteria isdifficult to avoid.Conclusions: Based on this meta-analysis of 24 months of clinical results, we conclude that theFE procedure is as effective as TDS but has the additional benefits of lower complication rates andsuperior perioperative parameters. In addition, patients may experience less pain with FE techniquesdue to a smaller incision and less operative injury. However, large-volume, well-designed RCTs withextensive follow-up are needed to confirm and update the findings of this analysis.Key words: Full-endoscopic, minimally invasive, discectomy, meta-analysis