EFFICACY OF ENDOSCOPIC SPINE SURGERY COMPARED TO MICRODISCECTOMY IN YOUNG PATIENTS WITH LUMBOSCIATALGIA

Abstract

Introduction: Lumbar disc herniation–related lumbosciatica is one of the leading causes of disability in young adults, directly affecting quality of life and work productivity. Conventional microdiscectomy is considered the gold standard for surgical treatment, but endoscopic spine surgery has emerged as a minimally invasive alternative. Objective: To review the scientific literature comparing the effectiveness of endoscopic spine surgery versus microdiscectomy in young patients with lumbosciatica. Methods: A narrative review was conducted in PubMed, Scopus, and SciELO databases, including publications from 2000 to 2023. Randomized clinical trials, prospective comparative studies, and meta-analyses involving patients under 45 years old were considered. Accepted languages: Portuguese, English, and Spanish. Isolated case reports and studies without comparative data were excluded. Results: Twenty-two studies were analyzed, totaling more than 4,100 patients. Endoscopic surgery showed equivalent results to microdiscectomy in pain improvement (mean VAS reduction from 6.8 to 2.1) and function (mean ODI reduction from 54% to 18%). Advantages of endoscopy included shorter hospital stays (1.2 days vs. 2.9 days), reduced intraoperative bleeding (average 55% reduction), and earlier return to work activities (2–3 weeks earlier). Complication rates were similar, although endoscopy presented a higher incidence of transient dysesthesias. Conclusion: Endoscopic spine surgery is effective and safe for young patients with lumbosciatica, providing important advantages in functional recovery. However, its widespread adoption still faces barriers related to the prolonged learning curve and high initial costs.