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Letter to the editor regarding, “Biportal endoscopic versus microscopic discectomy for lumbar herniated disc: A randomized controlled trial” by Park et al. Concepts, analyses and interpretation of noninferiority randomized controlled trials

Published:November 14, 2022DOI:https://doi.org/10.1016/j.spinee.2022.11.004
      It is with great interest and appreciation that we read the manuscript “Biportal Endoscopic versus Microscopic Discectomy for Lumbar Herniated Disc: A Randomized Controlled Trial” [
      • Park SM
      • Lee HJ
      • Park HJ
      • Choi JY
      • Kwon O
      • Lee S
      • et al.
      Biportal endoscopic versus microscopic discectomy for lumbar herniated disc: a randomized controlled trial.
      ]. In this RCT, Park et al. randomized 64 patients with sciatica due to lumbar disc herniation between biportal endoscopic discectomy (BED) and microdiscectomy. At 12 months after surgery, it was shown that the BED-group was non-inferior in functional disability as measured on the Oswestry Disability Index (ODI). Their manuscript is certainly of added value to the literature as it adds to the evidence on the equivalence in effectiveness of full-endoscopic procedures versus conventional open procedures. The study`s methodology, however, warrants some discussion.
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