Dear Spine Surgeon,
 
We would like to recommend you the latest scientific work by Hisashi KOGA MD., PhD, Director of Iwai FESS Clinic, The head of Education and Training Center, Iwai Orthopaedic Medical Hospital
 
Comparison of the Outcomes of Microendoscopic Discectomy Versus Full-Endoscopic Discectomy for the Treatment of L4/5 Lumbar Disc Herniation
 
Introduction
Several strategies are available for the treatment of lumbar disc herniation (LDH). Among these, microendoscopic discectomy (MED) and full-endoscopic discectomy (FED) are widely used in Japan, and the use of FED has been gradually increasing. The most recent annual report from the Japanese Orthopedic Society shows that the number of FEDs performed annually has reached approximately half that of MED [FED = 3499 cases, MED = 6884 cases].1 FED is an operative approach for uniportal full-endoscopic spine surgery (FESS).2 In contrast, MED is a combination of endoscopy and tubular surgery.3 The latter belongs to the group of “endoscopy-assisted surgeries,” together with unilateral biportal endoscopic (UBE) surgery, as seen in the recent classification proposed by AOSpine.4
 
FED seems to be more minimally invasive than MED; not only does it use a smaller skin incision, it also causes less damage to muscle and requires the removal of a smaller quantity of bone tissue.
Most recently, 1- and 2-year postoperative results of MED and FED were reported in a prospective randomized controlled study by Chen et al5,6; therein, the superiority of FED regarding clinical outcomes and safety was not shown. Furthermore, FED showed inferior results regarding median disc herniation.
 
These findings are completely contradictory to what we have noted in our personal experience. Specifically, FED via the transforaminal approach (TELD, transforaminal endoscopic lumbar discectomy) seems to be suitable for large central LDH.7 Previous studies regarding the operative outcomes for the treatment of LDH did not distinguish the different types of LDH.
 
Therefore, in this study, we compared operative outcomes between FED and MED only for L4/5 LDH, the most frequent site of LDH. In addition, we excluded intra- and extraforaminal LDHs because of the distinct superiority of FED over MED in these forms of LDH.8 To the best of our knowledge, this is the first comparative study on the treatment of L4/5 intracanal LDH between MED and FED.
Citation: Comparison of the Outcomes of Microendoscopic Discectomy Versus Full-Endoscopic Discectomy for the Treatment of L4/5 Lumbar Disc Herniation
Muneyoshi Fujita, MD, Takahiro Inui, MD https://orcid.org/0000-0003-4733-5281, […], and Hisashi Koga, MD, PhD
 
2023 by AO Spine, First published online September 22, 2022
 
Hisashi KOGA MD., PhD.
 
Director
Iwai FESS Clinic
The head of Education and Training Center
Iwai Orthopaedic Medical Hospital
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