SICOT2018: Better perioperative measures and patient satisfaction with endoscopic vs open discectomy .
OrthoEvidence Journal (OE Journal) - ACE Report
OE Journal. 2025;13(7):339 randomized controlled trials were included in this meta-analysis, which compared outcomes between endoscopic discectomy and open discectomy in patients undergoing treatment for lumbar disc herniation. For perioperative measures, endoscopic discectomy was significantly favoured for both blood loss and length of hospital stay. Postoperatively, patient satisfaction rates were significantly higher in endoscopic discectomy groups, while there was no significant difference between groups observed in grading of postoperative function through the Macnab criteria.
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Why was this study needed now?
Discectomy is often undergone following cases of lumbar disc herniation. Discectomy can be completed via a number of different techniques, including either open or endoscopic surgery. Despite previous randomized controlled trials on the topic, there is uncertainty if outcomes significantly differ between the open and endoscopic discectomy.
What was the principal research question?
In lumbar discectomy following lumbar disc herniation, is there a significant difference in perioperative measures, patient satisfaction, or postoperative function between endoscopic discectomy and open discectomy?
- Blood loss was significantly lower among endoscopic discectomy groups compared to open discectomy groups (MD -123.71mL [95%CI -173.47, -73.95]; p<0.00001).
- Length of hospital stay was significantly shorter among endoscopic discectomy groups compared to open discectomy groups (MD -144.45 [95%CI -239.54, -49.37]; p=0.003).
- Rate of patient satisfaction postoperatively was significantly higher among endoscopic discectomy groups (93.21%) compared to open discectomy groups (86.57%) (OR 2.19 [95%CI 1.09-4.40]; p=0.03).
- Grading of postoperative function using the Macnab criteria did not significantly differ between endoscopic discectomy groups and open discectomy groups (OR 3.72 [95%CI 0.76-18.14]; p=0.10).
What should I remember most?
In treatment of lumbar disc herniation, endoscopic discectomy was associated with reduced blood loss, shorter length of hospital stay, and greater patient satisfaction when compared to open discectomy, though no significant difference in postoperative function was observed between endoscopic and open discectomy.
How will this affect the care of my patients?
The results of this study suggest that endoscopic discectomy may be an effective alternative to open discectomy for patients undergoing lumbar discectomy following disc herniation. Continued study through randomized controlled trials is needed, with additional emphasis placed on potential complications and costs associated with each.
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