Comparing the efficacy and safety of biportal endoscopic discectomy with microscopic discectomy for lumbar herniated intervertebral disc: a multicentre, prospective, assessor-blinded, randomized controlled trial

Aims: The aim of this study was to compare the efficacy and safety of biportal endoscopic discectomy (BED) with microdiscectomy (MD) in patients with a single-level lumbar disc herniation, and to determine whether BED gives similar clinical outcomes to MD but with potential additional benefits. Methods: Included in this multicentre, prospective, assessor-blind, randomized controlled trial were patients with a single-level lumbar disc herniation requiring surgical intervention. These were recruited from six hospitals between 13 July 2021 and 16 September 2022, and followed up for 12 months. The interventions were either BED (n = 50) or MD (n = 50). The primary outcome was the Oswestry Disability Index (ODI) at 12 months postoperatively. Results: In total, 100 patients were randomized into the BED and MD groups based on computer-generated allocation. The analysis included 41 and 46 patients from the MD and BED groups, respectively. At 12 months, the mean ODI scores were comparable between the BED (10.92; SD 12.93) and MD (10.32; SD 12.55) groups (mean difference 0.61 (95% CI -4.47 to 5.68); p = 0.816). No serious adverse event was seen in either group. Compared to the MD group, the BED group showed slightly lower surgical site pain at 24 (p = 0.004) and 48 hours postoperatively (p = 0.014), lower serum creatine phosphokinase (CPK) (p = 0.003), better scar quality at three (p = 0.002) and six months (p = 0.007), and a significantly lower rate of wound dehiscence (p = 0.018). Conclusion: BED is as effective as MD in treating single-level lumbar disc herniation but has distinct advantages in terms of postoperative wound complications. Additionally, BED may offer potential benefits in terms of early postoperative surgical site pain, scar aesthetics, and muscle preservation as indicated by CPK levels. These findings suggest that BED is a safe and effective alternative to MD, offering the benefits of minimal invasiveness while maintaining clinical efficacy.