Transforaminal Versus Interlaminar Endoscopic Lumbar Discectomy for Lumbar Disc Herniation: A Systematic Review and Meta-Analysis

Abstract

Study Design Meta-analysis and systematic review. Objective This study aims to investigate and compare patient-reported outcomes, perioperative data, and complications between 2 common endoscopic approaches for lumbar disc herniation: transforaminal and interlaminar endoscopic lumbar discectomy, by published high-quality evidence. Methods Electronic databases were searched for reported outcomes following TELD and IELD. Oswestry Disability Index (ODI), visual analog scale of back (VASB) and leg pain (VASL), and MacNab criteria were evaluated. Operative time, hospital stays, blood loss, radiation exposure, and complications were investigated. Odds ratio (OR) and mean differences (MD) with 95% confidence intervals (CI) were calculated using random and fixed-effect models. Results Total of 1948 patients from 18 studies were included, consisting of 1006 patients (51.6%) in TELD group and 942 (48.4%) patients in IELD group. TELD had better improvement of postoperative ODI (MD = 1.26; 95% CI: .07-2.16; P = .04), postoperative VASB (MD = −.23; 95% CI: −.40 to −.05; P = .01) and last follow-up VASB (MD = −.25; 95% CI: −.41 to −.09; P = .002), but with longer operative time (MD = 10.1 min; 95% CI: 1.925-18.77; P < .00001) and more fluoroscopic time (SMD = 4.12; 95% CI: 3.22-5.03; P < .00001), especially in L5-S1 operation. Bed rest time was significantly longer following IELD, with no difference in VASL, hospital stays, or complication. Conclusion We found comparable clinical outcomes in terms of ODI, VAS, patient satisfaction, hospital stays, and complication between both techniques. TELD required more radiation exposure and longer operative time at L5-S1 level than IELD. Our study provided results to help consider appropriate approaches for selected patients and informed consent of benefits from each approach.

Interlaminar Endoscopic Lumbar Discectomy Versus Microscopic Lumbar Discectomy: A Preliminary Analysis of L5–S1 Lumbar Disc Herniation Outcomes in Prospective Randomized Controlled Trials

“…Following the upper limit of the 95% CI for the mean difference in VAS and ODI scores, our intention-to-treat analysis demonstrated that IELD was considered noninferior to MLD in terms terms of a shorter length of stay and reduced blood loss, consistent with previous different approach study. [37][38][39][40] However, the operation time is longer compared to the MLD procedure. The difference operation time between the 2 procedures were attributed to the distinct nature of both surgical procedures, such as patient-specific factors, equipment used, or the skill and experience of the surgeon.…”

Letter to editor regarding “The Efficacy and Safety of Topical Saline Irrigation with Tranexamic Acid on Perioperative Blood Loss in Patients Treated with PELD”

“…In both study groups, the authors indicate total blood loss (TBL) exceeding 300 ml and intraoperative blood loss (IBL) surpassing 40 ml. In contrast, a systematic review and meta-analysis by Jitpakdee et al (1) reported a range of blood loss from 10.9 ml to 23.35 ml for interlaminar endoscopic discectomy without any systemic or local use of tranexamic acid. Accurately assessing blood loss in endoscopic spine surgery poses a challenge, and the accuracy of indirect calculation methods is questionable, particularly when bleeding is minimal.…”

Comparison of Clinical and Radiographic Outcomes Between Transforaminal Endoscopic Lumbar Discectomy and Microdiscectomy: A Follow-up Exceeding 5 Years

“…The emergence of visual endoscopic technology has led to the development of transforaminal endoscopic lumbar discectomy (TELD), which is now gaining popularity as a treatment option [ 2 , 3 ]. Several studies have confirmed the excellent short-term clinical efficacy of TELD, and it is considered a treatment of choice for LDH because of its unique advantages of smaller incisions, decreased damage to soft tissues, and faster postoperative recovery [ 4 - 8 ]. However, the limited endoscopic field of view can increase the difficulty of the operation and the risk of incomplete resection of the nucleus pulposus [ 9 , 10 ].…”