title: Transforaminal endoscopic surgery for symptomatic lumbar disc herniations: a systematic review of the literature.
abstract: The study design includes a systematic literature review. The objective of the study was to evaluate the effectiveness of transforaminal endoscopic surgery and to compare this with open microdiscectomy in patients with symptomatic lumbar disc herniations. Transforaminal endoscopic techniques for patients with symptomatic lumbar disc herniations have become increasingly popular. The literature has not yet been systematically reviewed. A comprehensive systematic literature search of the MEDLINE and EMBASE databases was performed up to May 2008. Two reviewers independently checked all retrieved titles and abstracts and relevant full text articles for inclusion criteria. Included articles were assessed for quality and outcomes were extracted by the two reviewers independently. One randomized controlled trial, 7 non-randomized controlled trials and 31 observational studies were identified. Studies were heterogeneous regarding patient selection, indications, operation techniques, follow-up period and outcome measures and the methodological quality of these studies was poor. The eight trials did not find any statistically significant differences in leg pain reduction between the transforaminal endoscopic surgery group (89%) and the open microdiscectomy group (87%); overall improvement (84 vs. 78%), re-operation rate (6.8 vs. 4.7%) and complication rate (1.5 vs. 1%), respectively. In conclusion, current evidence on the effectiveness of transforaminal endoscopic surgery is poor and does not provide valid information to either support or refute using this type of surgery in patients with symptomatic lumbar disc herniations. High-quality randomized controlled trials with sufficiently large sample sizes are directly needed to evaluate if transforaminal endoscopic surgery is more effective than open microdiscectomy.
authors.affiliation: Department of Orthopaedics, EMGO Institute, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Jorm
authors.initials: J
authors.lastname: Nellensteijn
authors.forename: Raymond
authors.initials: R
authors.lastname: Ostelo
authors.forename: Ronald
authors.initials: R
authors.lastname: Bartels
authors.forename: Wilco
authors.initials: W
authors.lastname: Peul
authors.forename: Barend
authors.initials: B
authors.lastname: van Royen
authors.forename: Maurits
authors.initials: M
authors.lastname: van Tulder
mesh_terms: D017586:Diskectomy / Q000379:methods / Q000706:statistics & numerical data*; D004724:Endoscopy / Q000379:methods / Q000706:statistics & numerical data*; D006801:Humans; D007403:Intervertebral Disc / Q000473:pathology / Q000601:surgery*; D007405:Intervertebral Disc Displacement / Q000473:pathology / Q000601:surgery*; D008159:Lumbar Vertebrae / Q000473:pathology / Q000601:surgery*; D019060:Minimally Invasive Surgical Procedures / Q000379:methods / Q000706:statistics & numerical data*; D017063:Outcome Assessment, Health Care / Q000379:methods; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome