• Vit Kotheeranurak, Wongthawat Liawrungrueang, Javier Quillo-Olvera, Christoph J Siepe, Zhen Zhou Li, Pramod V Lokhande, Gun Choi, Yong Ahn, Chien-Min Chen, Kyung-Chul Choi, Facundo Van Isseldyk, Vincent Hagel, Sairyo Koichi, Christoph P Hofstetter, David Del Curto, Yue Zhou, Chen Bolai, Jun Seok Bae, Muhammed Assous, Guang-Xun Lin, Khanathip Jitpakdee, Yanting Liu, and Jin-Sung Kim.
• Department of Orthopedics, Faculty of Medicine, Chulalongkorn University, and King Chulalongkorn Memorial Hospital, Bangkok, Thailand.
• Spine. 2023 Apr 15; 48 (8): 534544534-544.

Study DesignA systematic review of the literature to develop an algorithm formulated by key opinion leaders.ObjectiveThis study aimed to analyze currently available data and propose a decision-making algorithm for full-endoscopic lumbar discectomy for treating lumbar disc herniation (LDH) to help surgeons choose the most appropriate approach [transforaminal endoscopic lumbar discectomy (TELD) or interlaminar endoscopic lumbar discectomy (IELD)] for patients.Summary Of Background DataFull-endoscopic discectomy has gained popularity in recent decades. To our knowledge, an algorithm for choosing the proper surgical approach has never been proposed.Materials And MethodsA systematic review of the literature using PubMed and MeSH terms was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Patient samples included patients with LDH treated with full-endoscopic discectomy. The inclusion criteria were interventional research (randomized and nonrandomized trials) and observation research (cohort, case-control, case series). Exclusion criteria were case series and technical reports. The criteria used for selecting patients were grouped and analyzed. Then, an algorithm was generated based on these findings with support and reconfirmation from key expert opinions. Data on overall complications were collected. Outcome measures included zone of herniation, level of herniation, and approach (TELD or IELD).ResultsIn total, 474 articles met the initial screening criteria. The detailed analysis identified the 80 best-matching articles; after applying the inclusion and exclusion criteria, 53 articles remained for this review.ConclusionsThe proposed algorithm suggests a TELD for LDH located in the foraminal or extraforaminal zones at upper and lower levels and for central and subarticular discs at the upper levels considering the anatomic foraminal features and the craniocaudal pathology location. An IELD is preferred for LDH in the central or subarticular zones at L4/L5 and L5/S1, especially if a high iliac crest or high-grade migration is found.Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.

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