Biportal Endoscopic Revision Discectomy Versus Open Microdiscectomy for Recurrent Lumbar Disc Herniation Without Instability: A Systematic Review and Meta-analysis - 06/08/26
, Akmal Abdurrahim TanCet article a été publié dans un numéro de la revue, cliquez ici pour y accéder
Highlights |
• | Biportal endoscopic revision discectomy was associated with a shorter hospital stay than open microdiscectomy for recurrent lumbar disc herniation. |
• | Long-term back pain scores were slightly lower after biportal surgery, although the absolute effect size was small. |
• | Operative time, MacNab outcome, recurrence, durotomy, and overall complications were comparable between biportal and open microdiscectomy. |
• | Trial sequential analysis suggested that the long-term back pain finding was statistically stable, whereas the hospital-stay finding remained promising but not conclusive. |
• | The current evidence is limited to a small number of retrospective comparative studies, supporting cautious interpretation of any apparent advantage. |
Abstract |
Background |
Revision surgery for recurrent lumbar disc herniation (RLDH) without instability is technically demanding because epidural scarring alters tissue planes. Biportal endoscopic revision discectomy may reduce access-related morbidity, but comparative evidence remains limited.
Objective |
To compare biportal endoscopic revision discectomy with open microdiscectomy for RLDH without instability.
Methods |
PubMed, Scopus, and ScienceDirect were searched from inception to 21 June 2026. Comparative adult studies were eligible. Random-effects meta-analyses calculated mean differences (MDs) and risk ratios (RRs) with 95% confidence intervals (CIs). Risk of bias was assessed using the seven-domain ROBINS-I tool. Exploratory trial sequential analysis (TSA) was performed for conventionally significant outcomes. The protocol was registered in PROSPERO (CRD420261429196).
Results |
Three retrospective studies including 208 patients were analyzed: 91 underwent biportal surgery and 117 underwent open microdiscectomy. Biportal surgery was associated with shorter hospital stay (MD, -1.54 days; 95% CI, -2.73 to -0.36; I² = 83%) and slightly lower long-term back-pain scores (MD, -0.37 points; 95% CI, -0.66 to -0.07; I² = 0%). TSA did not confirm firm evidence for hospital stay (DARIS = 503; final Z = 2.56; boundary not crossed), whereas the long-term back-pain Z-curve crossed the monitoring boundary (DARIS = 28; final Z = 2.46). No significant differences were found in operative time, long-term leg pain, MacNab outcome, recurrence, durotomy, or overall complications. All studies had serious overall risk of bias.
Conclusions |
Biportal endoscopic revision discectomy may offer recovery-related advantages, but current evidence remains preliminary and does not establish superiority, equivalence, or noninferiority.
Le texte complet de cet article est disponible en PDF.Keywords : biportal endoscopy, recurrent lumbar disc herniation, revision discectomy, microdiscectomy, meta-analysis, trial sequential analysis
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