title: Lumbar Endoscopic Microdiscectomy: Where Are We Now? An Updated Literature Review Focused on Clinical Outcome, Complications, and Rate of Recurrence.
abstract: Endoscopic disc surgery (EDS) for lumbar spine disc herniation is a well-known but developing field, which is increasingly spreading in the last few years. Rate of recurrence/residual, complications, and outcomes, in comparison with standard microdiscectomy (MD), is still debated and need further data. We performed an extensive review based on the last 6 years of surgical series, systematic reviews, and meta-analyses reported in international, English-written literature. Articles regarding patients treated through endoscopic transforaminal or interlaminar approaches for microdiscectomy (MD) were included in the present review. Papers focused on endoscopic surgery for other spinal diseases were not included. From July 2009 to July 2015, we identified 51 surgical series, 5 systematic reviews, and one meta-analysis reported. In lumbar EDS, rate of complications, length of hospital staying, return to daily activities, and overall patients' satisfaction seem comparable to standard MD. Rate of recurrence/residual seems higher in EDS, although data are nonhomogeneous among different series. Surgical indication and experience of the performing surgeon are crucial factors affecting the outcome. There is growing but still weak evidence that lumbar EDS is a valid and safe alternative to standard open microdiscectomy. Statistically reliable data obtained from randomized controlled trials (better if multicentric) are desirable to further confirm these results.
authors.affiliation: Department of Neuroscience, Neurosurgery, Imperial College of London, Charing Cross Hospital, London, UK.
authors.forename: Giulio
authors.initials: G
authors.lastname: Anichini
authors.affiliation: Department of Neurology and Psychiatry, Neurosurgery, University of Rome "Sapienza", Rome, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Landi
authors.affiliation: Department of Neurology and Psychiatry, Neurosurgery, University of Rome "Sapienza", Rome, Italy.
authors.forename: Federico
authors.initials: F
authors.lastname: Caporlingua
authors.affiliation: Department of Neurological Surgery, Wexner Medical Center, The Ohio State University College of Medicine, Columbus, OH, USA.
authors.forename: André
authors.initials: A
authors.lastname: Beer-Furlan
authors.affiliation: Department of Neurosurgery, King's College of London, London, UK.
authors.forename: Christian
authors.initials: C
authors.lastname: Brogna
authors.affiliation: Department of Neurology and Psychiatry, Neurosurgery, University of Rome "Sapienza", Rome, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Delfini
authors.affiliation: Department of Neurology and Psychiatry, Neurosurgery, University of Rome "Sapienza", Rome, Italy.
authors.forename: Emiliano
authors.initials: E
authors.lastname: Passacantilli
mesh_terms: D004724:Endoscopy / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D007403:Intervertebral Disc / Q000601:surgery*; D007405:Intervertebral Disc Displacement / Q000601:surgery*; D042282:Microdissection / Q000009:adverse effects / Q000379:methods*; D011183:Postoperative Complications