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

Abstract

INTRODUCTION: The endoscopic lumbar discectomy can be divided into two main approaches, transforaminal (TELD) and interlaminar endoscopic lumbar discectomy (IELD). However, results of comparative studies between these techniques have been inconsistent, and consensus on the decision making to select which approach has not been reached. METHODS: Three 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, 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 1,948 patients from 18 studies were included, consisting of 1,006 patients (51.6%) in TELD group and 942 (48.4%) patients in IELD group. TELD had slightly better improvement of postoperative ODI (MD = 1.26; 95% CI: 0.07–2.16; P = 0.04), postoperative VASB (MD = -0.23; 95% CI: -0.40 to -0.05; P = 0.01) and last follow-up VASB (MD = -0.25; 95% CI: -0.41 to -0.09; P = 0.002), but with longer operative time (MD = 10.1 mins; 95% CI: 1.925–18.77; P < 0.00001) and more fluoroscopic time (SMD = 4.12; 95% CI: 3.22–5.03; P < 0.00001), especially in L5-S1 operation. Postoperative bed rest time was significantly longer in IELD. However, there was no difference in VASL, hospital stays, or complication. CONCLUSIONS: 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 helpful results to consider which approach is suitable for selected patients and informed consent of benefits from each approach.