Does surgical treatment of lumbar disc herniation recurrence using the endoscopic technique improve radicular pain? A systematic review and meta-analysis

Araki, Jonathan Kioy Duarte; Lima, Mauricio Coelho; Mistro Neto, Sylvio; Rosa, André Frazão; Cavali, Paulo Tadeu Maia; Tebet, Marcos Antônio; da Silva, Cassio Cibreiros; Gehhlen, Samuel Henrique Jakoski; Risso Neto, Marcelo Italo

doi:10.1590/S1808-185120262501295354

Review Article: Minimally Invasive Surgery • Coluna/Columna. 25 (1) • 2026 • https://doi.org/10.1590/S1808-185120262501295354 linkcopy

Does surgical treatment of lumbar disc herniation recurrence using the endoscopic technique improve radicular pain? A systematic review and meta-analysis

O tratamento cirúrgico da recidiva da hérnia de disco lombar por técnica endoscópica melhora a dor radicular? Uma revisão sistemática e metanálise

¿El tratamiento quirúrgico de la recidiva de la hernia discal lumbar mediante técnica endoscópica mejora el dolor radicular? Una revisión sistemática y metaanálisis

Authorship SCIMAGO INSTITUTIONS RANKINGS

To evaluate the effectiveness of percutaneous endoscopic lumbar discectomy (PELD) in the treatment of recurrent lumbar disc herniation, comparing it with conventional techniques with an emphasis on the improvement of radicular pain. Systematic review and meta-analysis of 6 studies with statistical analysis using the fixed-effect Mantel-Haenszel model and Cochran’s Q test for heterogeneity. Improvement in radicular pain was assessed using the Visual Analog Scale (VAS), and recurrence rates were evaluated using relative risk (RR), adopting a significance level of 0.05%. A total of 622 patients were included (55% male, 45% female) with a mean age of 46 years. The endoscopic technique reduced VAS scores by more than 23% compared to traditional techniques. Disability scales, evaluated through measures of central tendency, showed no significant differences between techniques. Recurrence rates in the experimental (endoscopic) group were 4.7%, with a pooled RR of 3.66 (95% CI: 1.8–5.1) and high heterogeneity (I² = 95%). There was no significant difference in recurrence rates based on follow-up duration (mean of 2 years). The endoscopic technique was effective in improving radicular pain in the surgical treatment of recurrent lumbar disc herniation, and when compared to the conventional technique, this improvement was 23% greater based on the analysis of visual analog scale (VAS) scores. Level of Evidence I; Systematic^c reviewb of Level I RCTs (and study results were homogenous^c)

Keywords:
Orthopedics; Surgery; Spine; Herniated Disc; Minimally Invasive Surgical Procedures

	Q Test	p Value	I²
Coefficient	18.262	< 0.0001	95%
Heterogeneity residual test	54.12	< 0.0001	-

Parameters	Number of studies	Number of patients	Mean RR	CI -lower	CI - Upper
Grouped results	6	622	3.6	1.8	5.1
Analysis date
Between 2008 and 2014	2 (33.3%)	349 (56.1%)	4.3	2.7	6.1
Between 2015 and 2020	4 (66.6%)	273 (43.9%)	3.0	1.9	5.3

Parameters	Average	CI -lower	CI - Upper	p-value
Disability scale by endoscopic technique	20.2	18.5	22.4	> 0.05
Disability scale by conventional technique*	24.0	21.1	27.2	> 0.05
Surgery time by endoscopic technique	58 min	37 min	94 min	> 0.05
Surgery times by conventional technique	142 min	85 min	189 min	> 0.05
Complications during surgery in the endoscopic technique	5.2%	4.2%	6.4%	> 0.05
Complications during surgery in the conventional technique	7.1%	6.2%	8.0%	> 0.05
Complications after surgery in the endoscopic technique**	-	-	-	-
Complications after surgery in the conventional technique**
Length of hospital stay in the endoscopic technique	12 days	10 days	14 days	< 0.05
Length of hospital stay in the conventional technique	14 days	9 days	19 days	< 0.05

Authors and year	Number of patients	Data source	Difference between recurrences based on a mean of 2 years of follow-up (between conventional and endoscopic techniques)
Hoogland et al. (2008)³	262	Department of Spine Surgery, Alpha Klinik Munich, Germany	p > 0.05
Ruetten et al. (2009)⁶	87	Department of Spine Surgery and Pain Therapy, Orthopedics and Traumatology Center, St. Anna-Hospital Herne, Herne, Germany	p > 0.05
Zhuhai et al. (2015)⁷	56	Department of Orthopedics, Western China Hospital of Sichuan University	p > 0.05
Yao et al. (2017)⁸	74	Department of Orthopedics, Xinqiao Hospital, Third Military Medical University, Chongqing, China	p > 0.05
Lee et al. (2018)⁹	83	Department of Neurosurgery, Jooan Nanoori Hospital, Seoul, South Korea	p > 0.05
Goker and Aydin (2020)¹⁰	60	Istinye University, Faculty of Medicine, Liv Ulus Hospital, Department of Neurosurgery, Istanbul, Turkey	p > 0.05

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[TN1] ^*
Not defined in all 6 articles observed.

[TN2] ^**
Complications after surgeries were not defined in all 6 articles observed.

[3] Note: Average of 4.45 for the endoscopic technique and 5.79 for the conventional techniques (t-test: p = 0.06), indicating a 23.6% reduction in score for endoscopic techniques.