TY - JOUR
T1 - Operative Approaches for Lumbar Disc Herniation
T2 - A Systematic Review and Multiple Treatment Meta-Analysis of Conventional and Minimally Invasive Surgeries
AU - Alvi, Mohammed Ali
AU - Kerezoudis, Panagiotis
AU - Wahood, Waseem
AU - Goyal, Anshit
AU - Bydon, Mohamad
N1 - Publisher Copyright:
© 2018 Elsevier Inc.
PY - 2018/6
Y1 - 2018/6
N2 - Background: Minimally invasive surgery (MIS) techniques have emerged as viable and safe alternatives for lumbar disc herniation, including percutaneous discectomy, percutaneous endoscopic discectomy, and tubulardiscectomy (TD). We present here a systematic review and a multiple-treatment meta-analysis evaluating the operative outcomes and patient-reported outcomes of open/microdiscectomy (OD/MD) and all MIS approaches for lumbar disc herniation. Methods: The PICO approach and PRISMA (i.e., Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were followed to query existing online databases since their inception to 2016, which yielded 14 studies after we applied the inclusion/exclusion criteria. The Cochrane Collaboration's tool for assessing risk of bias in randomized trials was used to assess the risk of bias in each study was used to assess the risk of bias in each study. Each outcome was assessed across all studies with the GRADE (i.e., Grading of Recommendations, Assessment, Development and Evaluations) criteria. Results: There were 1707 patients analyzed, with 782 (45.81%) undergoing OD/MD, 491 (28.76%) undergoing TD, 199 (11.65%) undergoing percutaneous endoscopic discectomy, and 235 (13.76%) patients undergoing percutaneous discectomy. TD was found to be associated with significantly worse Oswestry Disability Index scores (mean difference 1.17, P = 0.03) whereas OD/MD was associated with worse Oswestry Disability Index scores compared with all other approaches (mean difference 2.61, P = 0.03), significantly longer duration of stay (mean difference 2.96, P = 0.04), and more blood loss (mean difference 30.53, P < 0.001). In terms of complications, TD was found to be associated with a greater rate of overall complications (odds ratio [OR] 1.49, P = 0.002), greater incidence of dural tears (OR 1.72 P = 0.04), and recurrent herniation (OR 2.09, P = 0.0007). Finally, OD/MD was associated with significantly lower incidence of revision surgery (OR 0.53, P = 0.0007). Conclusions: Our meta-analysis revealed that tubular-discectomy and percutaneous-endoscopic-discectomy, the most commonly employed MIS techniques for discectomy, can be used as safe alternatives for open discectomy depending on the preference of the operating surgeon.
AB - Background: Minimally invasive surgery (MIS) techniques have emerged as viable and safe alternatives for lumbar disc herniation, including percutaneous discectomy, percutaneous endoscopic discectomy, and tubulardiscectomy (TD). We present here a systematic review and a multiple-treatment meta-analysis evaluating the operative outcomes and patient-reported outcomes of open/microdiscectomy (OD/MD) and all MIS approaches for lumbar disc herniation. Methods: The PICO approach and PRISMA (i.e., Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were followed to query existing online databases since their inception to 2016, which yielded 14 studies after we applied the inclusion/exclusion criteria. The Cochrane Collaboration's tool for assessing risk of bias in randomized trials was used to assess the risk of bias in each study was used to assess the risk of bias in each study. Each outcome was assessed across all studies with the GRADE (i.e., Grading of Recommendations, Assessment, Development and Evaluations) criteria. Results: There were 1707 patients analyzed, with 782 (45.81%) undergoing OD/MD, 491 (28.76%) undergoing TD, 199 (11.65%) undergoing percutaneous endoscopic discectomy, and 235 (13.76%) patients undergoing percutaneous discectomy. TD was found to be associated with significantly worse Oswestry Disability Index scores (mean difference 1.17, P = 0.03) whereas OD/MD was associated with worse Oswestry Disability Index scores compared with all other approaches (mean difference 2.61, P = 0.03), significantly longer duration of stay (mean difference 2.96, P = 0.04), and more blood loss (mean difference 30.53, P < 0.001). In terms of complications, TD was found to be associated with a greater rate of overall complications (odds ratio [OR] 1.49, P = 0.002), greater incidence of dural tears (OR 1.72 P = 0.04), and recurrent herniation (OR 2.09, P = 0.0007). Finally, OD/MD was associated with significantly lower incidence of revision surgery (OR 0.53, P = 0.0007). Conclusions: Our meta-analysis revealed that tubular-discectomy and percutaneous-endoscopic-discectomy, the most commonly employed MIS techniques for discectomy, can be used as safe alternatives for open discectomy depending on the preference of the operating surgeon.
KW - Disc herniation
KW - Discectomy
KW - Minimally invasive surgery
KW - Open surgery
KW - Patient-reported outcomes
KW - Spine surgery
KW - Surgical outcomes
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UR - http://www.scopus.com/inward/citedby.url?scp=85046120017&partnerID=8YFLogxK
U2 - 10.1016/j.wneu.2018.02.156
DO - 10.1016/j.wneu.2018.02.156
M3 - Review article
C2 - 29548960
AN - SCOPUS:85046120017
SN - 1878-8750
VL - 114
SP - 391-407.e2
JO - World neurosurgery
JF - World neurosurgery
ER -