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

ABSTRACT 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; Systematicc reviewb of Level I RCTs (and study results were homogenousc)