Surgical treatment of lumbar prolapsed intervertebral disc (PIVD): A comprehensive review comparing conventional microdiscectomy versus endoscopic discectomy – emphasis on recurrence rates

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Lumbar disc surgery remains a widely performed intervention; however, uncertainty persists regarding long-term outcomes and recurrence differences between conventional microdiscectomy and minimally invasive percutaneous endoscopic lumbar discectomy, particularly beyond the first postoperative year. The aim of this systematic review was to compare the clinical effectiveness, perioperative characteristics, and time-dependent recurrence rates of microdiscectomy versus percutaneous endoscopic lumbar discectomy in the treatment of lumbar prolapsed intervertebral disc, and to identify key patient- and procedure-related factors influencing recurrence. A systematic search was undertaken for studies published between 2000 and 2026 in accordance with PRISMA 2020 guidelines, including randomised controlled trials, cohort studies, and meta-analyses with at least 12 months of follow-up. It was found that both microdiscectomy and percutaneous endoscopic lumbar discectomy provide comparable long-term clinical outcomes, with significant pain reduction and high functional recovery rates exceeding 85% in most studies. Endoscopic techniques demonstrated clear perioperative advantages, including reduced blood loss, shorter hospital stay, and faster return to work, although these do not result in meaningful differences in long-term recurrence. Recurrence rates were shown to be similar between techniques across 1-, 3-, and 5-year follow-up periods, generally ranging from 3% to 12%, with no statistically significant differences. Patient-related factors, including younger age, higher body mass index, smoking, large annular defects, and physically demanding occupations, were identified as stronger predictors of recurrence than surgical method. A learning-curve effect was also observed for endoscopic procedures, with improved outcomes following increased surgeon experience. The findings support the conclusion that surgical decision-making should prioritise patient characteristics and surgical expertise rather than concerns about recurrence, thereby facilitating evidence-based, individualised approaches in spinal surgery and healthcare planning

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