Open versus endoscopic approaches for disc herniations: case illustrations and a comprehensive literature review

Background and Objective: The field of minimally invasive spine surgery (MISS) has seen many recent advancements. This evolution is especially true for the surgical treatment of degenerative disc disease. Although the gold standard for the treatment of symptomatic disc herniation has been open microdiscectomy (OMD), the popularity of endoscopic discectomy (ED) is rapidly rising due to its association with a quicker recovery and preservation of the paraspinal musculature. The objective of this review is to compare the surgical techniques utilized to surgically treat disc herniation and discuss the transition to a less invasive surgery.

Methods: A query of PubMed articles was performed in 2024 using the terms open microdiscectomy and endoscopic microdiscectomy. The query focused primarily on full text articles, written in English and articles published between March 2001 and November 2024. Subsequently, all selected manuscripts underwent full review.

Key Content and Findings: OMD remains a reliable and safe surgical technique for disc herniation, but results in paraspinal muscle disruption. Alternatively, the less invasive endoscopic approach has been associated with a reduction of intraoperative blood loss, length of hospital stay, and short-term disability.

Conclusions: Because of the characteristics associated with a less invasive procedure, we suggest that the endoscopic technique should be considered in patients with a symptomatic disc herniation recalcitrant to conservative treatment.