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. 2023 Apr 15;48(8):534-544.
doi: 10.1097/BRS.0000000000004589. Epub 2023 Feb 6.

Full-Endoscopic Lumbar Discectomy Approach Selection: A Systematic Review and Proposed Algorithm

Vit Kotheeranurak  1   2 , Wongthawat Liawrungrueang  3 , Javier Quillo-Olvera  4 , Christoph J Siepe  5   6 , Zhen Zhou Li  7 , Pramod V Lokhande  8 , Gun Choi  9 , Yong Ahn  10 , Chien-Min Chen  11 , Kyung-Chul Choi  12 , Facundo Van Isseldyk  13 , Vincent Hagel  14 , Sairyo Koichi  15 , Christoph P Hofstetter  16 , David Del Curto  17 , Yue Zhou  18 , Chen Bolai  19 , Jun Seok Bae  20 , Muhammed Assous  21 , Guang-Xun Lin  22   23 , Khanathip Jitpakdee  24 , Yanting Liu  25 , Jin-Sung Kim  25
Affiliations

Full-Endoscopic Lumbar Discectomy Approach Selection: A Systematic Review and Proposed Algorithm

Vit Kotheeranurak et al. Spine (Phila Pa 1976). .

Abstract

Study design: A systematic review of the literature to develop an algorithm formulated by key opinion leaders.

Objective: This study aimed to analyze currently available data and propose a decision-making algorithm for full-endoscopic lumbar discectomy for treating lumbar disc herniation (LDH) to help surgeons choose the most appropriate approach [transforaminal endoscopic lumbar discectomy (TELD) or interlaminar endoscopic lumbar discectomy (IELD)] for patients.

Summary of background data: Full-endoscopic discectomy has gained popularity in recent decades. To our knowledge, an algorithm for choosing the proper surgical approach has never been proposed.

Materials and methods: A systematic review of the literature using PubMed and MeSH terms was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Patient samples included patients with LDH treated with full-endoscopic discectomy. The inclusion criteria were interventional research (randomized and nonrandomized trials) and observation research (cohort, case-control, case series). Exclusion criteria were case series and technical reports. The criteria used for selecting patients were grouped and analyzed. Then, an algorithm was generated based on these findings with support and reconfirmation from key expert opinions. Data on overall complications were collected. Outcome measures included zone of herniation, level of herniation, and approach (TELD or IELD).

Results: In total, 474 articles met the initial screening criteria. The detailed analysis identified the 80 best-matching articles; after applying the inclusion and exclusion criteria, 53 articles remained for this review.

Conclusions: The proposed algorithm suggests a TELD for LDH located in the foraminal or extraforaminal zones at upper and lower levels and for central and subarticular discs at the upper levels considering the anatomic foraminal features and the craniocaudal pathology location. An IELD is preferred for LDH in the central or subarticular zones at L4/L5 and L5/S1, especially if a high iliac crest or high-grade migration is found.

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Conflict of interest statement

The authors report no conflicts of interest.

References

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    1. Lin G-X, Kotheeranurak V, Mahatthanatrakul A, et al. Worldwide research productivity in the field of full-endoscopic spine surgery: a bibliometric study. Eur Spine J. 2020;29:153–60.
    1. Ruetten S, Komp M, Merk H, et al. Full-endoscopic interlaminar and transforaminal lumbar discectomy versus conventional microsurgical technique: a prospective, randomized, controlled study. Spine (Phila Pa 1976). 2008;33:931–99.
    1. Chen Z, Zhang L, Dong J, et al. Percutaneous transforaminal endoscopic discectomy compared with microendoscopic discectomy for lumbar disc herniation: 1-year results of an ongoing randomized controlled trial. J Neurosurg Spine. 2018;28:300–10.
    1. Gibson JNA, Subramanian AS, Scott CEH. A randomised controlled trial of transforaminal endoscopic discectomy vs microdiscectomy. Eur Spine J. 2017;26:847–56.

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