A SYSTEMATIC LITERATURE REVIEW AND META-ANALYSIS OF BIPORTAL ENDOSCOPY VERSUS MICROSCOPIC DISCECTOMY IN LUMBAR DISC HERNIATION SURGERY: A COMPARATIVE ASSESSMENT OF OUTCOMES

Background: Biportal Endoscopic Spine Surgery (BESS) is an emerging minimally invasive alternative to Microscopic Discectomy (MD) for lumbar disc herniation (LDH). However, the comparative effectiveness of BESS versus MD remains uncertain. Methods: Following PRISMA guidelines, we searched PubMed, EBSCOhost, and Scopus (2000-2024). We included studies comparing BESS and MD for LDH. Outcomes analyzed were operative time, blood loss, postoperative pain (VAS), functional recovery (ODI), hospital stay, and complication rates. A random-effects metaanalysis was performed.
Methods: Following PRISMA guidelines, we searched PubMed, EBSCOhost, and Scopus (2000-2024). We included studies comparing BESS and MD for LDH. Outcomes analyzed were operative time, blood loss, postoperative pain (VAS), functional recovery (ODI), hospital stay, and complication rates. A random-effects meta-analysis was performed.
Results: Four studies (n = 252 patients) were included. BESS was associated with a significantly shorter hospital stay but a longer operative time. Differences in pain reduction (VAS) and functional recovery (ODI) favored BESS but were not statistically significant. Bleeding and mJOA scores showed high heterogeneity and non-significant differences.
Conclusion: BESS offers potential benefits in hospital stay and recovery but lacks definitive superiority over MD. Larger, high-quality RCTs are needed to draw firmer conclusions.