Superiority Analysis of Endoscopic Discectomy Compared to Microdiscectomy

Introduction: With the gaining popularity of the endoscopic approach in the management of lumbar disc disease, endoscopic discectomy (ED) has also become one of the common methods of surgical management.6 Although ED had limited indications in the earlier days, with the advancement in the technology and tools used, the domains of its use have been extended. Moreover, with its advantages like surgery under local anaesthesia, less damage to the bone and paraspinal musculature and fast postoperative recovery ED is taking over the place ofMDin the management of lumbar disc disease.We performed this meta-analysis to evaluate whether Endoscopic Discectomy (ED) shows superiority compared to the current gold standard Microdiscectomy (MD) in management of lumbar disc disease. Materials and Methods: We conducted independent and duplicate electronic database search including PubMed, Embase and Cochrane Library from 1990 till April 2020 for studies comparing ED and MD in the management of lumbar disc disease. Analysis was performed in R platform using OpenMetaAnalyst software. Results: We included 27 studies including 11 RCTs, 7 non-randomized prospective and 9 retrospective studies involving 4018 patients in meta-analysis. We stratified the results based on the study design. Considering the heterogeneity in some results between study designs, we weighed our conclusion essentially based on results of RCTs. On analysing RCTs, superiority was established at 95\% confidence interval for ED compared to MD in terms of functional outcomes like ODI score (P = .008), duration of surgery (P = .023), length of hospital stay (P {\textless}.001) although significant heterogeneity was noted. Similarly, non-inferiority to MD was established by ED in other outcomes like VAS score for back pain (P = .860) and leg pain (P = .495), MacNab classification (P = .097), recurrences (P = .993) and reoperations (P = .740) and return to work period (P = .748). Conclusion: Our meta-analysis established the superiority of endoscopic discectomy in outcome measures like ODI score, duration of surgery, overall complications, length of hospital stay and non-inferiority in other measures analysed. With recent advances in the field of ED, the procedure has the potential to take over the place of MD as the gold standard of care in management of lumbar disc disease.