title: Systematic review of microendoscopic discectomy for lumbar disc herniation.
abstract: METHODS
  Systematic review.
  
  
  OBJECTIVE
  To search and analyse randomised controlled trials (RCTs) published since the Cochrane review by Gibson and Waddell (2007) comparing microendoscopic discectomy (MED) with open discectomy (OD) or microdiscectomy (MD) and to assess whether MED improves patient-reported outcomes. Discectomy for symptomatic herniated lumbar discs is an effective operative treatment. A number of operative techniques exist including OD, MD, and MED. A 2007 Cochrane review identified OD as an effective treatment for symptom improvement, and found sufficient evidence for MD. However, evidence for MED was lacking.
  
  
  METHODS
  A systematic review of Medline and Embase was carried out. Aiming to identify RCTs carried out after 2007, which compared OD with MD and MED which reported the Oswestry disability index (ODI) as an outcome.
  
  
  RESULTS
  Four RCTs were identified. None of the studies found a significant difference in the ODI scores between study groups at any time point. Three studies compared MED to OD and one compared OD, MD, and MED. The largest study reported an increased number of severe complications in the MED group.
  
  
  CONCLUSIONS
  There is some evidence to suggest that MED performed by surgeons skilled in the technique in tertiary referral centres is as effective as OD.
authors.affiliation: Department of Trauma and Orthopaedics, University Hospitals Coventry and Warwickshire, Coventry, UK, nickasmith@doctors.org.uk.
authors.forename: Nick
authors.initials: N
authors.lastname: Smith
authors.forename: James
authors.initials: J
authors.lastname: Masters
authors.forename: Cyrus
authors.initials: C
authors.lastname: Jensen
authors.forename: Almas
authors.initials: A
authors.lastname: Khan
authors.forename: Andrew
authors.initials: A
authors.lastname: Sprowson
mesh_terms: D017586:Diskectomy / Q000379:methods*; D004724:Endoscopy; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000150:complications / Q000601:surgery*; D008159:Lumbar Vertebrae / Q000601:surgery*; D008866:Microsurgery; D016032:Randomized Controlled Trials as Topic; D012585:Sciatica / Q000209:etiology / Q000601:surgery*; D016896:Treatment Outcome