Full-Endoscopic Procedures Versus Traditional
Discectomy Surgery for Discectomy: A
Systematic Review and Meta-analysis of
Current Global Clinical Trials
Authors: Huang Chun-Ming 
Published: February 2021

Background: Traditional discectomy surgery (TDS) provides good or excellent results in clinical
surgical discectomy but may induce neural adhesion, spinal structural damage, instability, and
other complications. The potential advantages of full-endoscopic (FE) procedures over standard
TDS include less blood loss, less postoperative pain, shorter hospitalization, and an earlier return to
work. However, more evidence is needed to support this new technology in clinical applications.
Objective: The aim of this systematic review and meta-analysis was to compare the safety and
efficacy of FE and TDS.
Study Design: Comprehensive systematic review and meta-analysis of the literature.
Methods: Electronic databases, including PubMed, EMBASE, SinoMed, and Cochrane Library,
were searched to identify clinical therapeutic trials comparing FE to TDS for discectomy.
Results: Six trials comprising 730 patients were included, and the overall quality of the literature
was moderate, including 4 Grade I levels of evidence (4 randomized controlled trials, [RCTs]) and 2
Grade II levels (2 non-RCTs). The pooled data revealed no difference in reoperation rates between FE
and TDS (P = 0.94), but the complication rate was significantly lower in the FE group (3.86%) than
in the TDS group (11.4%). Perioperative parameters (operation time, blood loss, hospitalization
time, and return to work days) were significantly lower in the FE group (P < 0.05 for all groups
using either score). Postoperative pain and neurology score assessments were conducted at 4
different time points at 3 months, 6 months, 12 months, and 24 months. Significant differences
were detected in the following: lumbar North American Spine Society (NASS) pain at 6 months (P
= 0.008); cervical NASS neurology at 6 months (P = 0.03); visual analog scale (VAS) score in leg at
3 months (P < 0.001); VAS score in arm at 24 months (P = 0.002); VAS score in neck at 3 months,
6 months, and 12 months after therapy (P = 0.003, P = 0.004, P = 0.01); and VAS score in neck at
3 months and 6 months (P = 0.01, P = 0.004). Moreover, the pooled data revealed no statistically
significant differences in improvements in the Oswestry disability index (ODI), instability (X-ray),
and Hilibrand criteria (P > 0.05 for all groups).
Limitations: Only 6 studies were included, 4 of which had the same authors. Between-study
heterogeneity due to differences in socioeconomic factors, nutrition, and matching criteria is
difficult to avoid.
Conclusions: Based on this meta-analysis of 24 months of clinical results, we conclude that the
FE procedure is as effective as TDS but has the additional benefits of lower complication rates and
superior perioperative parameters. In addition, patients may experience less pain with FE techniques
due to a smaller incision and less operative injury. However, large-volume, well-designed RCTs with
extensive follow-up are needed to confirm and update the findings of this analysis.
Key words: Full-endoscopic, minimally invasive, discectomy, meta-analysis