Long-term outcomes of primary percutaneous endoscopic lumbar discectomy: systematic review and meta-analysis.

Abstract

Systematic review and meta-analysis. To evaluate long-term functional, radiological, and surgical outcomes of percutaneous endoscopic lumbar discectomy (PELD). Early studies suggest that PELD achieves outcomes comparable to those of microdiscectomy with less perioperative morbidity and faster recovery, although technical challenges contribute to a steep learning curve. Long-term data remain sparse, and observational studies are necessary to assess late outcomes. A systematic search of the PubMed, Embase, and Scopus databases was performed based on the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Studies that reported outcomes at ≥5 years after PELD were included. The Visual Analog Scale (VAS) for leg and back pain, Oswestry Disability Index (ODI), Japanese Orthopedic Association score, disc height, range of motion (ROM), complication rates, recurrent herniation, and reoperation rates were assessed. Data were extracted and pooled using random-effects meta-analysis as appropriate. The risk of bias was assessed using the National Institute of Health Quality Assessment Tool. Nine studies including 2,369 patients undergoing transforaminal or interlaminar PELD with a mean follow-up of ≥5 years were analyzed. Pooled functional outcomes at ≥5 years were favorable: VAS (leg) 1.09, VAS (back) 1.18, and ODI 11.98. The proportion of patients with good/excellent results according to the MacNab criteria was 88%. Recurrence and reoperation rates were 6% and 7%, respectively, similar to those reported after microdiscectomy in historical cohorts. Radiological outcomes showed modest disc height reduction and preserved ROM without evidence of long-term instability based on flexion-extension ROM. Most complications were early, transient, and infrequent. PELD may provide sustained symptom relief and low rates of complication, recurrence, and reoperation in long-term follow-up. Late clinical and functional outcomes appear to be favorable. However, the predominance of retrospective data and selective loss to follow-up limits the strength of the conclusions.