Clinical utility and transparency in randomized trials of biportal endoscopic lumbar discectomy: a systematic review
In brief
Four trials of biportal discectomy omit cost and assessor-blinding details
A review of four randomized trials involving 324 patients found they addressed clinically relevant questions, but none reported value for money or blinded outcome assessors. Average usefulness scores were 18 of 26; apparent changes in clinical utility and transparency over time were not statistically significant. Better preregistration, data sharing, and cost evaluation are needed to strengthen evidence for the procedure.
- Journal
- Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia (Q2)
- Published
- 19 October 2026
- Study design
- Systematic review / meta-analysis of RCTs
- Evidence level
- Level 1, High (CEBM 1a)
- Authors
- Jonathan J Huang, Clara W Rodrigues-Cheung, Srikar Chintala, Junho Song, Samuel K Cho
- PMID
- 42896244
- DOI
- 10.1016/j.jocn.2026.112334
Why clinicians should know about it
- Picked for Spine Surgery (top studies of the week, 25 October 2026): Systematic review appraises trials of minimally invasive lumbar discectomy
Abstract
INTRODUCTION: Unilateral biportal endoscopic discectomy has grown rapidly as a minimally invasive treatment for lumbar disc herniation, supported by an expanding body of randomized controlled trials. However, randomization alone does not guarantee a trial is clinically useful, and no prior study has evaluated whether these trials are designed and reported in a way that supports confident clinical decision-making. The Van't Hooft framework assesses this dimension directly, scoring clinical utility and transparency separately from conventional risk-of-bias tools, addressing a gap left by prior appraisals focused on effect estimates alone. METHODS: A systematic review of PubMed, Cochrane Library, and Scopus identified randomized controlled trials evaluating unilateral biportal endoscopic discectomy for lumbar disc herniation. Two reviewers independently screened studies and scored each included trial using the Van't Hooft framework, yielding clinical utility (maximum 14), transparency (maximum 12), and total usefulness (maximum 26) scores. Item-level frequencies and temporal trends by publication year were summarized descriptively and with univariable linear regression. RESULTS: Four trials (324 patients) met inclusion criteria. Mean clinical utility was 9.5±1.0, mean transparency was 8.5±1.3, and mean total usefulness was 18.0±0.8. Value-for-money reporting and assessor blinding were absent in all four trials. Clinical utility rose nonsignificantly over time (β = 0.519/year, P = 0.222), while transparency declined nonsignificantly (β = -0.815/year, P = 0.053). CONCLUSION: Randomized trials of biportal endoscopic discectomy address clinically relevant, patient-centered questions but report transparency inconsistently. Future trials should prioritize preregistration, data sharing, and cost evaluation to strengthen the evidence base guiding this increasingly common procedure.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.