Jietao Xu1, Yawei Li1, Bing Wang2, Guohua Lv1, Lei Li1, Yuliang Dai1, Bin Jiang1, Zhenzhong Zheng1. 1. Department of Spine Surgery, the Second Xiangya Hospital, Central South University, Changsha, China. 2. Department of Spine Surgery, the Second Xiangya Hospital, Central South University, Changsha, China. Electronic address: wbxyeyy@csu.edu.cn.
Abstract
BACKGROUND: Minimally invasive surgery in the treatment of lumbar disc herniation has gained popularity in recent years, as 2 dominant techniques, percutaneous endoscopic lumbar discectomy (PELD) and microendoscopic discectomy (MED) obtained comparable short-term clinical outcomes. However, midterm and long-term efficacy and reoperative rate are still debated. METHODS: Electronic databases Web of Science, PubMed, Scopus, Cochrane Library, EMBASE, Ovid, and EBSCO were searched. STATA 14.0 was used for statistical analysis. Odds ratio (OR) and 95% confidence interval (CI) were pooled to quantify the strength of the statistical differences. RESULTS: Nine studies (468 patients in the PELD group and 516 patients in the MED group) with high methodologic quality met the selection criteria. No differences were found in leg pain visual analog scale score before surgery or at any follow-up time after surgery. PELD obtained better outcomes in low back pain visual analog scale score, Oswestry Disability Index score, and excellent and good ratio after 24 months postoperatively (OR = -0.856, 95% CI -1.488 to -0.224, P = 0.008; OR = -0.425, 95% CI -0.724 to -0.127, P = 0.005; OR = 3.034; 95% CI 1.254 to 7.343; P = 0.014) compared with MED. No difference was found within 24 months postoperatively. No significant differences were found in complication, recurrence, and reoperation rates within and after 2 years postoperatively. CONCLUSIONS: Both PELD and MED can offer relatively effective and safe treatment for low back pain and radiculopathy associated with a herniated disc. PELD could obtain better midterm and long-term clinical outcomes compared with MED.
BACKGROUND: Minimally invasive surgery in the treatment of lumbar disc herniation has gained popularity in recent years, as 2 dominant techniques, percutaneous endoscopic lumbar discectomy (PELD) and microendoscopic discectomy (MED) obtained comparable short-term clinical outcomes. However, midterm and long-term efficacy and reoperative rate are still debated. METHODS: Electronic databases Web of Science, PubMed, Scopus, Cochrane Library, EMBASE, Ovid, and EBSCO were searched. STATA 14.0 was used for statistical analysis. Odds ratio (OR) and 95% confidence interval (CI) were pooled to quantify the strength of the statistical differences. RESULTS: Nine studies (468 patients in the PELD group and 516 patients in the MED group) with high methodologic quality met the selection criteria. No differences were found in leg pain visual analog scale score before surgery or at any follow-up time after surgery. PELD obtained better outcomes in low back pain visual analog scale score, Oswestry Disability Index score, and excellent and good ratio after 24 months postoperatively (OR = -0.856, 95% CI -1.488 to -0.224, P = 0.008; OR = -0.425, 95% CI -0.724 to -0.127, P = 0.005; OR = 3.034; 95% CI 1.254 to 7.343; P = 0.014) compared with MED. No difference was found within 24 months postoperatively. No significant differences were found in complication, recurrence, and reoperation rates within and after 2 years postoperatively. CONCLUSIONS: Both PELD and MED can offer relatively effective and safe treatment for low back pain and radiculopathy associated with a herniated disc. PELD could obtain better midterm and long-term clinical outcomes compared with MED.
Authors: Jin-Sung Kim; Jun Ho Lee; Junseok Bae; Dong Chan Lee; Sang-Ha Shin; Han Joong Keum; Young Soo Choi; Sang Soo Eun; Seung Ho Shin; Hyun Jin Hong; Ji Yeon Kim; Tae Hyun Kim; Woojung Lim; Junghoon Kim; Sang-Min Park; Hyun-Jin Park; Hong-Jae Lee Journal: J Orthop Surg Res Date: 2022-03-28 Impact factor: 2.359