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Percutaneous endoscopic lumbar discectomy for LDH via a transforaminal approach versus an interlaminar approach: a meta-analysis

Perkutane endoskopische lumbale Diskektomie bei lumbalem Bandscheibenvorfall mittels transforaminaler vs. interlaminarer Verfahren: eine Metaanalyse

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Abstract

Purpose

The aim of this study was to systematically compare the safety and effectiveness of percutaneous endoscopic transforaminal discectomy (PETD) versus percutaneous endoscopic interlaminar discectomy (PEID) for the treatment of lumbar disc herniation (LDH).

Material and methods

All studies that were performed to compare PETD with PEID to treat LDH and published until 31 August 2017 were acquired through a comprehensive search in various databases. A meta-analysis was performed using the Cochrane Collaboration’s RevMan 5.3 software.

Results

A total of 13 trials with 974 cases consisting of 3 randomized controlled trials, 3 prospective studies and 7 retrospective studies were included. The results suggest that patients treated with PEID experienced more significant advantages with shorter operation time, less intraoperative blood loss and less intraoperative fluoroscopy times but more complications than those treated with PETD; however, the two operative approaches did not significantly differ in terms of LDH recurrence, hospital stay, Oswestry disability index (ODI) scores, visual analogue scale (VAS) scores, Japanese Orthopaedic Association (JOA) scores and MacNab criteria at the final follow-up.

Conclusion

Based on the results of this study, although PEID may be superior to PETD in certain ways, some of its advantages have yet to be verified and the two interventions were not significantly different in terms of relief of symptoms and functional recovery. Therefore, PEID would be recommended for treating LDH especially at L5/S1 under certain conditions but a prudent attitude is necessary to choose between the two operative approaches before a large sample and high quality randomized controlled trials have been performed.

Zusammenfassung

Zweck

Das Ziel dieser Studie war es, die Sicherheit und Wirksamkeit der perkutanen endoskopischen transforaminalen Diskektomie (PETD) zur Behandlung lumbaler Bandscheibenvorfälle („lumbar disc herniation“, LHD) systematisch zu vergleichen.

Material und Methoden

Alle Studien, die durchgeführt wurden, um die PETD mit der PEID zur Behandlung eines LDH zu vergleichen und bis 31. August 2017 veröffentlicht worden waren, wurden aus einer umfassenden Suche in verschiedenen Datenbanken extrahiert. Eine Metaanalyse wurde mittels Cochrane Collaboration’s RevMan 5.3 software durchgeführt.

Ergebnisse

Insgesamt wurden 13 Studien mit 974 Fällen, die jeweils 3 randomisierte kontrollierte, 3 prospektive und 7 retrospektive Studien beinhalten, wurden eingeschlossen. Die Ergebnisse zeigen, dass Patienten, die mit PEID behandelt wurden, mehr signifikante Vorteile durch eine kürzere Operationszeit, weniger intraoperativen Blutverlust sowie eine kürzere intraoperative Fluoroskopiedauer zeigten, allerdings auch mehr Komplikationen aufwiesen als Patienten, die mittels PETD behandelt wurden. Jedoch unterschieden sich die beiden Operationsverfahren beim letzten Follow-up nicht signifikant hinsichtlich eines erneuten Auftretens eines LDH, Hospitalisationsdauer, Oswestry-Disability-Index(ODI)-Scores, Scores der visuellen Analogskala (VAS), Japanese-Orthopaedic-Association(JOA)-Scores und MacNab-Kriterien.

Schlussfolgerung

Obwohl die PEID der PETD in mancher Hinsicht überlegen sein mag, müssen einige Vorteile auf Grundlage der Ergebnisse dieser Studie noch verifiziert werden. Die beiden Operationsverfahren unterschieden sich nicht signifikant hinsichtlich Symptomlinderung und Wiederherstellung der Funktionsfähigkeit. Daher wäre die PEID zur Behandlung von LDH unter gewissen Umständen insbesondere an L5/S1 zu empfehlen. Jedoch ist die Entscheidung für das ein oder andere Operationsverfahren mit Bedacht zu treffen, bis randomisierte kontrollierte Studien mit größeren Fallzahlen und hoher Qualität durchgeführt wurden.

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Abbreviations

CBRG:

Cochrane back review group

JOA:

Japanese Orthopaedic Association

LDH:

Lumber disc herniation

NOQAS:

Newcastle Ottawa quality assessment scale

ODI:

Oswestry disability index

PEID:

Percutaneous endoscopic interlaminar discectomy

PELD:

Percutaneous endoscopic lumbar discectomy

PETD:

Percutaneous endoscopic transforaminal discectomy

RoB:

Risk of bias

TESSYS:

Transforaminal endoscopic spine system

VAS:

Visual analogue scale

YESS:

Yeung endoscopic spine system

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Author contributions

Yongjing Huang and Jianjian Yin wrote the main manuscript text, and YinZhuang, Xueguang Liu and Shihao Du prepared the figures. Zhenzhong Sun, Yongjun Rui and Sheng Song compiled the data.

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Authors and Affiliations

  1. Department of Orthopedics, Wuxi 9th People’s Hospital Affiliated to Soochow University, 999 Liangxilu, 214000, Wuxi, Binghu, China

    Yongjing Huang, Zhenzhong Sun, Sheng Song, Yin Zhuang, Xueguang Liu, Shihao Du & Yongjun Rui

  2. Department of Orthopedics, The Affiliated Changzhou No.2 People’s Hospital with Nanjing Medical University, 213003, Changzhou, China

    Jianjian Yin

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  1. Yongjing Huang
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Correspondence to Zhenzhong Sun or Sheng Song.

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Conflict of interest

Y. Huang, J. Yin, Z. Sun, S. Song, Y. Zhuang, X. Liu, S. Du and Y. Rui declare that they have no competing interests.

For this article no studies with human participants or animals were performed by any of the authors. All studies performed were in accordance with the ethical standards indicated in each case.

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The authors Yongjing Huang and Jianjian Yin contributed equally to the manuscript.

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Huang, Y., Yin, J., Sun, Z. et al. Percutaneous endoscopic lumbar discectomy for LDH via a transforaminal approach versus an interlaminar approach: a meta-analysis. Orthopäde 49, 338–349 (2020). https://doi.org/10.1007/s00132-019-03710-z

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