Background: Low back pain (LBP), affecting ~10% of the global population, is a major public health challenge, with elevated prevalence in China (20.88–29.88%). Lumbar disc herniation (LDH), a leading cause of LBP (12–43% of cases), involves nucleus pulposus displacement and annulus fibrosus compromise. While conservative therapies resolve symptoms in 75% of patients, refractory cases necessitate surgery. Percutaneous Endoscopic Lumbar Discectomy (PELD) is a minimally invasive option with favorable outcomes. This systematic review and meta-analysis evaluate the efficacy of minimally invasive surgeries for LDH, focusing on pain reduction, functional improvement, and recurrence.
Methods: Following PRISMA guidelines, PubMed, Scopus, and Web of Science were systematically searched using keywords related to LDH, minimally invasive surgery, and clinical outcomes. Eligible studies included confirmed LDH diagnoses, detailed surgical data, and postoperative outcome measures. Two researchers independently screened articles and extracted data. Meta-analyses (RevMan 5.4, STATA 17.0) employed random-effects models to calculate mean differences (MDs) and odds ratios (ORs). Sensitivity and publication bias analyses were conducted.
Results: Among 11,626 screened articles, 14 studies (1,108 patients) met inclusion criteria. All procedures significantly reduced back and leg pain at 3, 6, and 12 months postoperatively. Unilateral Biportal Endoscopic (UBE) surgery demonstrated the largest improvements in Visual Analog Scale (VAS) scores for back and leg pain across all intervals. PELD with annular suture yielded the highest Oswestry Disability Index (ODI) improvements (MD: 65.32 at 3 months; 70.93 at 12 months). UBE also outperformed other techniques in functional outcomes. Recurrence rates between Microendoscopic Lumbar Discectomy (MELD) and PELD were comparable (OR: 0.90; 95% CI: 0.37–2.22).
Conclusion: Minimally invasive surgeries, particularly UBE and PELD with annular suture, significantly improve pain and function in LDH patients. Despite methodological heterogeneity, results robustly support their efficacy. Personalized surgical selection and standardized protocols are critical to optimizing outcomes. Future research should prioritize identifying patient-specific predictors of success to guide precision interventions. This analysis provides evidence-based insights to enhance clinical decision-making and patient quality of life.