Early Pain and Functional Recovery Following Endoscopic Lumbar Discectomy for Lumbar Disc Herniation: A Systematic Review

Abstract

Lumbar disc herniation (LDH) is a common cause of low back and radicular pain that may require surgery when conservative treatment fails. This systematic review evaluated early postoperative pain and functional outcomes following endoscopic lumbar discectomy (ELD) compared with conventional discectomy or other surgical approaches. The review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. PubMed/MEDLINE, ScienceDirect, Springer Nature, and Scopus were searched for English-language studies published between August 31, 2016, and August 31, 2026. Eligible studies involved adults with primary LDH undergoing transforaminal ELD and assessed pain and/or function using the Visual Analog Scale (VAS) or Oswestry Disability Index (ODI) within three months after surgery. Risk of bias was assessed using the Cochrane Risk of Bias 2 tool. Owing to clinical and methodological heterogeneity, findings were synthesized narratively. Five randomized controlled trials involving 1,720 participants were included. All reported early improvements in pain and/or function, although between-group differences varied. Some trials found greater early functional improvement with ELD, particularly in ODI, whereas others reported outcomes comparable to conventional discectomy. All trials raised some concerns regarding risk of bias. ELD was associated with early postoperative improvement; however, its superiority over conventional discectomy remains inconclusive. Further multicenter randomized trials using standardized outcome measures and follow-up protocols are warranted.