O IMPACTO DAS TÉCNICAS MINIMAMENTE INVASIVAS NO TRATAMENTO DA HÉRNIA DE DISCO LOMBAR: REVISÃO SISTEMÁTICA E META-ANÁLISE

Abstract

Lumbar disc herniation is one of the leading causes of lumbosciatica and disability worldwide. Conventional microdiscectomy has been considered the gold standard, but over the past two decades, minimally invasive techniques, such as endoscopic discectomy, have been developed with the promise of reducing morbidity, hospital stay, and accelerating recovery. This systematic review and meta-analysis aimed to compare the efficacy, safety, and cost-effectiveness of minimally invasive techniques versus conventional microdiscectomy. PubMed, Scopus, Web of Science, and SciELO databases were searched until December 2023, including randomized controlled trials and prospective comparative studies. Outcomes assessed included pain (VAS), functional disability (ODI), hospital stay, complications, recurrence, learning curve, and costs. Eighteen studies were included, with a total of 3,246 patients. Results showed comparable clinical efficacy between techniques, with shorter hospital stay (1.2 vs. 2.8 days; p<0.01) and less intraoperative bleeding in the endoscopic groups. However, the learning curve was significantly longer (30–50 cases to achieve proficiency) and initial costs were higher due to specific equipment requirements. In conclusion, minimally invasive techniques demonstrate clinical equivalence to microdiscectomy, but with perioperative advantages and challenges related to costs and training. Wider adoption will depend on structured training strategies, resource availability, and integration of new technologies such as robotics and 3D navigation.