Background: Surgical treatment of lumbar disc herniation is a widely debated topic, with several techniques available. Percutaneous endoscopic discectomy (PELD) has gained popularity due to its lower invasiveness compared to conventional techniques such as microdiscectomy/open lumbar microdiscectomy (OLMD)/tubular microdiscectomy (TMD). However, evidence on the effectiveness, recovery time and complications of these techniques is not yet clearly established. This systematic review aims to compare the preoperative and postoperative outcomes of both techniques. Methods: A comprehensive search was performed in databases including PubMed and Cochrane, following strict inclusion and exclusion criteria. Comparative studies and narrative reviews on PELD and OLMD/TMD published between 2019 and 2024 were included. Key outcomes considered were pre- and postoperative Visual Analogue Scale (VAS), hospitalization time, time to return to work, and postoperative complications. Results: The reviewed studies indicated that PELD is associated with a greater reduction in postoperative pain compared to OLMD/TMD, with a significant decrease in VAS, according to the study by Priola et al. (2019). The hospital stay was also shorter for patients undergoing PELD, averaging 2 days compared to OLMD/TMD. Furthermore, PELD favored a faster return to work and had a lower rate of postoperative complications, such as dural tears and reoperations, compared to OLMD/TMD. Conclusions: PELD demonstrates clear advantages over OLMD/TMD in terms of pain reduction, shorter hospital stay, faster return to work, and fewer postoperative complications. However, the implementation of this technique requires a significant learning curve, suggesting that its effectiveness may vary depending on the surgeon’s experience. PELD should be considered a preferred option in the resection of lumbar disc herniations, especially in patients seeking a quick and less invasive recovery.
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