• Nick Smith, James Masters, Cyrus Jensen, Almas Khan, and Andrew Sprowson.
• Department of Trauma and Orthopaedics, University Hospitals Coventry and Warwickshire, Coventry, UK, nickasmith@doctors.org.uk.
• Eur Spine J. 2013 Nov 1; 22 (11): 2458-65.

Study DesignSystematic review.ObjectiveTo search and analyse randomised controlled trials (RCTs) published since the Cochrane review by Gibson and Waddell (2007) comparing microendoscopic discectomy (MED) with open discectomy (OD) or microdiscectomy (MD) and to assess whether MED improves patient-reported outcomes. Discectomy for symptomatic herniated lumbar discs is an effective operative treatment. A number of operative techniques exist including OD, MD, and MED. A 2007 Cochrane review identified OD as an effective treatment for symptom improvement, and found sufficient evidence for MD. However, evidence for MED was lacking.MethodsA systematic review of Medline and Embase was carried out. Aiming to identify RCTs carried out after 2007, which compared OD with MD and MED which reported the Oswestry disability index (ODI) as an outcome.ResultsFour RCTs were identified. None of the studies found a significant difference in the ODI scores between study groups at any time point. Three studies compared MED to OD and one compared OD, MD, and MED. The largest study reported an increased number of severe complications in the MED group.ConclusionsThere is some evidence to suggest that MED performed by surgeons skilled in the technique in tertiary referral centres is as effective as OD.

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