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.