AB148. SOH25_AB_253. Percutaneous endoscopic discectomy vs. microdiscectomy in the elderly for primary lumbar disc herniation: a systematic meta-regression

Background: Percutaneous endoscopic lumbar discectomy (PELD) offers a less invasive alternative, potentially minimising complications and shortening recovery with the possibility of same-day discharge where local anaesthetic is used. However, there are no direct comparisons of PELD vs. microdiscectomy (MD) in the elderly.

Methods: A systematic search of PubMed, Scopus, and Embase databases was conducted to find comparative trials from inception to January 30, 2024. For inclusion studies had to compare one of length of stay (LoS), complication rate, re-herniation rate, revision rate, or patient-reported outcome measures (PROMs) following PELD and MD indicated for primarily lumbar disc herniation (LDH). Reports not investigating the lumbar spine and studies describing other pathology were excluded. Bayesian meta-regression was performed using summary data from reports to extrapolate LoS, complication rate, re-herniation rate, reoperation rate, and PROMs following PELD and MD up to age 80 years.

Results: Thirty-one studies met inclusion criteria. Included patients had a mean age of 43.3 years, ranging from 18.0 to 56.7 years. LoS post-PELD was lower than for MD across all ages. Complication rates were similar for both procedures among the elderly. The risk of disc re-herniation and further surgery appear to increase with age, particularly after PELD. Functional outcomes were equivalent between both procedures and all ages

Conclusions: This study ratifies that PELD is viable in the elderly imparting a swifter recovery postoperatively than MD. This may be at the cost of a greater long-term rate of recurrent herniation and reoperation, however the influence of learning curve effects on this finding is unclear.

Keywords: Endoscopy; lumbar disc herniation (LDH); microdiscectomy (MD); percutaneous endoscopic lumbar discectomy (PELD); spine