This prospective randomized controlled trial compared full-endoscopic lumbar discectomy against conventional microsurgical discectomy. The endoscopic arm used both interlaminar and transforaminal approaches selected by herniation location. Patients were followed for 2 years using VAS, NASS, and Oswestry outcome measures.
The decision rule here is straightforward: if clinical outcomes are equal, choose the approach that spares more tissue. This trial showed full-endoscopic discectomy matches microdiscectomy on leg pain relief and recurrence, while cutting operating time, blood loss, bony resection, and return-to-work time.
Approach selection depends on herniation location. Use the transforaminal route for intra- and extraforaminal herniations, and the interlaminar route for herniations inside the canal that sit beyond the transforaminal working window. Remember the anular defect drives recurrence more than the technique does. A large defect predicts recurrence whether you go open or endoscopic.
The main caveat is generalizability. This was a single-center trial by two highly experienced surgeons, and the authors explicitly flag a steep learning curve, so early results in less-experienced hands may differ.
This prospective randomized controlled trial compared full-endoscopic lumbar discectomy against conventional microsurgical discectomy. The endoscopic arm used both interlaminar and transforaminal approaches selected by herniation location. Patients were followed for 2 years using VAS, NASS, and Oswestry outcome measures.
The decision rule here is straightforward: if clinical outcomes are equal, choose the approach that spares more tissue. This trial showed full-endoscopic discectomy matches microdiscectomy on leg pain relief and recurrence, while cutting operating time, blood loss, bony resection, and return-to-work time.
Approach selection depends on herniation location. Use the transforaminal route for intra- and extraforaminal herniations, and the interlaminar route for herniations inside the canal that sit beyond the transforaminal working window. Remember the anular defect drives recurrence more than the technique does. A large defect predicts recurrence whether you go open or endoscopic.
The main caveat is generalizability. This was a single-center trial by two highly experienced surgeons, and the authors explicitly flag a steep learning curve, so early results in less-experienced hands may differ.