Advertisement

Der Orthopäde

, Volume 47, Issue 7, pp 574–584 | Cite as

Meta-analysis of percutaneous transforaminal endoscopic discectomy vs. fenestration discectomy in the treatment of lumbar disc herniation

  • Weilan Ding
  • Jianjian Yin
  • Ting Yan
  • Luming Nong
  • Nanwei Xu
Originalien

Abstract

Objective

The aim of this study was to systematically review the efficacy of percutaneous transforaminal endoscopic discectomy (PTED) and fenestration discectomy (FD) in the treatment of lumbar disc herniation (LDH).

Material and methods

We performed a systematic search in MEDLINE, EMBASE, PubMed, Web of Science, Cochrane databases, Chinese Biomedical Literature Database, CNKI, and Wanfang Data for all relevant studies. All statistical analyses wer performed using Review Manager version 5.3. Dichotomous data were calculated by odds ratio (OR) and continuous data were calculated by mean difference (MD) with 95% confidence intervals (CI).

Results

A total of 17 articles with 1390 study subjects were included, with 733 patients in the PTED group and 657 patients in the FD group. The results of the meta-analysis showed that postoperative the visual analog scale (VAS) score (mean difference [MD] −0.13; 95% confidence interval [CI] −0.22 to −0.03; P = 0.009) and postoperative complications (MD 0.52; 95% CI 0.26 to 1.04; P = 0.06) showed no significant differences between the PTED group and the FD group, while the PTED group had significantly better results in operation time (MD 0.47; 95% CI −11.34 to 12.28; P = 0.94), length of incision (MD −3.74; 95% CI −4.28 to −3.19; P < 0.00001), amount of bleeding (MD −63.66, 95% CI −77.65 to −49.67; P < 0.00001), time of postoperative bed rest (MD −90.19; 95% CI −106.82 to −73.56; P < 0.00001), hospitalization time (MD −5.90; 95% CI −7.21 to −4.59; P < 0.00001), and postoperative Oswestry disability index (ODI) score (MD −0.59; 95% CI −1.11 to −0.08; P = 0.02) compared with the FD group.

Conclusion

The Percutaneous transforaminal endoscopic discectomy is associated with better postoperative ODI score, better results in length of incision, lower blood loss, shorter operation time, postoperative bed time and hospitalization time. The complications did not differ significantly between PTED and FD in the treatment of lumbar disc herniation. These findings provide evidence to support PTED is efficacious for LDH; however, scar repair of a ruptured anulus fibrosus needs a long time and the patients undergoing PTED should be advised to stay in bed for a long time even if the symptoms are markedly relieved. These results are not limited to randomized controlled trials and lack data about the long-term outcome.

Keywords

Retrospective study Surgical procedures Postoperative complications Length of stay Annulus fibrosus 

Abbreviations

FD

Fenestration discectomy

LDH

Lumbar disc herniation

NOS

Newcastle-Ottawa scale

ODI

Oswestry disability index

PELD

Percutaneous endoscopic lumbar discectomy

PRISMA

Preferred reporting items for systematic reviews and meta-analyses

PTED

Percutaneous transforaminal endoscopic discectomy

TF-PELD

Transforaminal percutaneous endoscopic lumbar discectomy

VAS

Postoperative visual analogue score

Metaanalyse der perkutanen transforaminalen endoskopischen Diskektomie im Vergleich zur Fensterungsdiskektomie in der Behandlung des lumbalen Bandscheibenvorfalls

Zusammenfassung

Ziel

Ziel der Studie war eine systematische Übersicht der Wirksamkeit der perkutanen transforaminalen endoskopischen Diskektomie (PTED) und der Fensterungsdiskektomie (FD) in der Behandlung des lumbalen Bandscheibenvorfalls (LBV).

Material und Methoden

Wir führten eine systematische Literatursuche nach allen relevanten Studien in MEDLINE, EMBASE, PubMed, Web of Science, Cochrane-Datenbanken, Chinese Biomedical Literature Database, CNKI und Wanfang Data durch. Alle statistischen Analysen erfolgten mit dem Review Manager, Version 5.3. Bei dichotomen Daten wurde die Odds Ratio (OR) berechnet, bei kontinuierlichen Daten die Mittelwertdifferenz (MD) mit 95 %-Konfidenzintervall (KI).

Ergebnisse

Insgesamt 17 Beiträge mit 1390 Studienteilnehmern wurden eingeschlossen, darunter 733 Patienten in der PTED-Gruppe und 657 Patienten in der FD-Gruppe. Die Metaanalyse ergab, dass sich der postoperative Wert auf der visuellen Analogskala (VAS; MD −0,13; 95 %-KI −0,22 bis −0,03; P = 0,009) und die postoperativen Komplikationen (MD 0,52; 95 %-KI 0,26 bis 1,04; P = 0,06) nicht signifikant zwischen PTED- und FD-Gruppe unterschieden, während die PTED-Gruppe im Vergleich zur FD-Gruppe signifikant bessere Ergebnisse in der Operationszeit (MD 0,47; 95 %-KI −11,34 bis 12,28; P = 0,94), der Schnittlänge (MD −3,74; 95 %-KI −4,28 bis −3,19; P < 0,00001), dem Blutverlust (MD −63,66, 95 %-KI −77,65 bis −49,67; P < 0,00001), der Dauer der postoperativen Bettruhe (MD −90,19; 95 %-KI −106,82 bis −73,56; P < 0,00001), der Krankenhausverweildauer (MD −5,90; 95 %-KI −7,21 bis −4,59; P < 0,00001) und dem postoperativen Oswestry-Disability-Index(ODI)-Wert (MD −0,59; 95 %-KI −1,11 bis −0,08; P = 0,02) aufwies.

Schlussfolgerung

Die PTED ist mit einem besseren postoperativen ODI-Wert, besseren Ergebnissen bezüglich der Schnittlänge, einem geringeren Blutverlust sowie einer kürzeren Operationsdauer, postoperativen Bett ruhe und Krankenhausverweildauer assoziiert. Die Komplikationen im Rahmen der Behandlung lumbaler Bandscheibenvorfälle unterschieden sich nicht signifikant zwischen PTED und FD. Diese Ergebnisse stützen die Aussage, dass die PTED bei LBV wirksam ist. Allerdings dauert die Narbenheilung eines rupturierten Anulus fibrosus lange. Des Weiteren sollte dem Patienten nach PTED zu einer langen Bettruhe geraten werden, auch wenn die Symptome schon deutlich nachgelassen haben. Diese Ergebnisse sind durch das Fehlen randomisierter, kontrollierter Studien eingeschränkt. Des Weiteren mangelt es an Daten zum langfristigen Outcome.

Schlüsselwörter

Retrospektive Studie Chirurgische Verfahren Postoperative Komplikationen Verweildauer Anulus fibrosus 

Notes

Funding

Dr. Nong Luming: the fifth phase project “333 Project” of Jiangsu Province in 2017 (BRA2017120), Changzhou International Scientific and Technological Cooperation Project (CZ20170021), Jiangsu Postdoctoral Research supported project (1701001 A), the Project of Invigorating Health Care through Science, Technology and Education (Jiangsu Provincial Medical Youth Talent) and Changzhou city high level health personnel training project (2016CZBJ029).

Compliance with ethical guidelines

Conflict of interest

W. Ding, J. Yin, T. Yan, L. Nong and N. Xu declare that they have no competing interests.

This article does not contain any studies with human participants or animals performed by any of the authors.

References

  1. 1.
    Ahlgren BD, Lui W, Herkowitz HN, Panjabi MM, Guiboux JP (2000) Effect of anular repair on the healing strength of the intervertebral disc: a sheep model. Spine (Phila Pa 1976) 25(17):2165–2170CrossRefGoogle Scholar
  2. 2.
    Ahn SS, Kim SH, Kim DW, Lee BH (2016) Comparison of outcomes of percutaneous endoscopic lumbar discectomy and open lumbar microdiscectomy for young adults: a retrospective matched cohort study. World Neurosurg 86:250–258CrossRefPubMedGoogle Scholar
  3. 3.
    Arts M, Brand R, van der Kallen B, Lycklama a Nijeholt G, Peul W (2011) Does minimally invasive lumbar disc surgery result in less muscle injury than conventional surgery? A randomized controlled trial. Eur Spine J 20(1):51–57CrossRefPubMedGoogle Scholar
  4. 4.
    Bruggeman AJ, Decker RC et al (2011) Surgical treatment and outcomes of lumbar radiculopathy. Phys Med Rehabil Clin N Am 22(1):161–177.  https://doi.org/10.1016/j.pmr.2010.10.002 (Review)CrossRefPubMedGoogle Scholar
  5. 5.
    Campbell P, Wynne-Jones G, Muller S et al (2013) The influence of employment social support for risk and prognosis in nonspecific back pain: a systematic review and critical synthesis. Int Arch Occup Environ Health 86:119–137CrossRefPubMedGoogle Scholar
  6. 6.
    Chang HK, Chang HC, Wu JC et al (2016) Scoliosis may increase the risk of recurrence of lumbar disc herniation after microdiscectomy. J Neurosurg Spine 24(4):586–591CrossRefPubMedGoogle Scholar
  7. 7.
    Chen Gong et al (2016) Comparison of percutaneous endoscopic lumbar discectomy and open lumbar surgery for single segment disc herniation. Shandong Med J 56(27):87–89Google Scholar
  8. 8.
    Chen HC, Lee CH et al (2015) Comparison of percutaneous endoscopic lumbar discectomy and open lumbar surgery for adjacent segment degeneration and recurrent disc herniation. Neurol Res Int.  https://doi.org/10.1155/2015/791943 PubMedPubMedCentralCrossRefGoogle Scholar
  9. 9.
    Chen HT, Tsai CH, Chao SC et al (2011) Endoscopic discectomy of L5-S1 disc herniation via an interlaminar approach: prospective controlled study under local and general anesthesia. Surg Neurol Int 2:93.  https://doi.org/10.4103/2152-7806.82570 CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Choi KC, Kim JS, Ryu KS et al (2013) Percutaneous endoscopic lumbar discectomy for L5-S1 disc herniation: transforaminal versus interlaminar approach. Pain Physician 16(6):547–556PubMedGoogle Scholar
  11. 11.
    Clavien PA, Puhan MA (2014) Biased reporting in surgery. Br J Surg 101:591–592CrossRefPubMedGoogle Scholar
  12. 12.
    Danjie J et al (2017) Comparative study of percutaneous transforaminal endoscopic discectomy versus fenestration discectomy in patients with lumbar disc herniation. Chin J Min Inv Surg 17(6):491–494Google Scholar
  13. 13.
    Ding Z, Tao Y et al (2017) Clinical outcomes of percutaneous transforaminal endoscopic discectomy versus fenestration discectomy in patients with lumbar disc herniation. J Int Transl Med 5(1):29–33Google Scholar
  14. 14.
    Fairbank JC, Pynsent PB (2000) The Oswestry disability index. Spine (Phila Pa 1976) 25(22):2940–2952 (discussion 2952)CrossRefGoogle Scholar
  15. 15.
    Gadjradj PS, van Tulder MW, Dirven CM et al (2016) Clinical outcomes after percutaneous transforaminal endoscopic discectomy for lumbar disc herniation: a prospective case series. Neurosurg Focus 40(2):E3CrossRefPubMedGoogle Scholar
  16. 16.
    Moher D, Liberati A, Tetzlaff J, Altman DG, Group P (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Plos Med 6:e1000097CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Heo JH, Kim CH, Chung CK et al (2017) Quantity of disc removal and radiological outcomes of percutaneous endoscopic lumbar discectomy. Pain Physician 20(5):E737–E746PubMedGoogle Scholar
  18. 18.
    Higgins JPT, Green S (2011) Cochrane handbook for systematic reviews of interventions Version 5.1.0. The Cochrane Collaboration, LondonGoogle Scholar
  19. 19.
    Kang HAN, Haoran GAO et al (2015) Comparison of clinical efficacy of percutaneous transforaminal endoscopic discectomy with simple vertebral lamina fenestration in treatment of lumbar disc herniation. Chin J Gen Pract 13(6):868–869Google Scholar
  20. 20.
    Karakaşlı A, Yıldız DV, Kumtepe E et al (2013) Biomechanical comparison of intact lumbar lamb spine and endoscopic discectomized lamb spine. Eklem Hastalik Cerrahisi 24(1):33–38.  https://doi.org/10.5606/ehc.2013.08 PubMedCrossRefGoogle Scholar
  21. 21.
    Kim MJ, Lee SH, Jung ES (2007) Targeted percutaneous transforaminal endoscopic diskectomy in 295 patients: comparison with results of microscopic diskectomy. Surg Neurol 68:623–631CrossRefPubMedGoogle Scholar
  22. 22.
    Lee DY, Shim CS, Ahn Y et al (2009) Comparison of percutaneous endoscopic lumbar discectomy and open lumbar microdiscectomy for recurrent disc herniation. Korean Neurosurg Soc 46(6):515–521CrossRefGoogle Scholar
  23. 23.
    Li J, Ma C et al (2015) A comparison of results between percutaneous transforaminal endoscopic discectomy and fenestration discectomy for lumbar disc herniation in the adolscents. Zhonghua Yi Xue Za Zhi 95(47):15Google Scholar
  24. 24.
    Li X, Han Y, Di Z et al (2016) Percutaneous endoscopic lumbar discectomy for lumbar disc herniation. J Clin Neurosci 33:19–27CrossRefPubMedGoogle Scholar
  25. 25.
    Liu J et al (2014) A prospective and controlled study of percutaneous transforaminal endoscopic discectomy versus fenestration discectomy for lumbar disc herniation. Chin J Bone Joint 3(4):245–250Google Scholar
  26. 26.
    Nie H, Zeng J, Song Y, Chen G et al (2016) Percutaneous endoscopic lumbar discectomy for L5-S1 disc herniation via an Interlaminar approach versus a transforaminal approach: a prospective randomized controlled study with 2‑year follow up. Spine (Phila Pa 1976) 41(Suppl 19):B30–B37CrossRefGoogle Scholar
  27. 27.
    Pan L, Zhang P, Yin Q (2014) Comparison of tissue damages caused by endoscopic lumbar discectomy and traditional lumbar discectomy: a randomized controlled trial. Int J Surg 12:534–537CrossRefPubMedGoogle Scholar
  28. 28.
    Pirvu T, Blanquer SB, Benneker LM et al (2015) A combined biomaterial and cellular approach for annulus fibrosus rupture repair. Biomaterials 42:11–19CrossRefPubMedGoogle Scholar
  29. 29.
    Postacchini F, Postacchini R (2011) Operative management of lumbar disc herniation : the evolution of knowledge and surgical techniques in the last century. Acta Neurochir Suppl 108:17–21.  https://doi.org/10.1007/978-3-211-99370-5_4 (Review)CrossRefPubMedGoogle Scholar
  30. 30.
    Rasouli MR, Rahimi-Movaghar V, Shokraneh F, Moradi-Lakeh M, Chou R (2014) Minimally invasive discectomy versus microdiscectomy/open discectomy for symptomatic lumbar disc herniation. Cochrane Database Syst Rev.  https://doi.org/10.1002/14651858.CD010328.pub2 PubMedCrossRefGoogle Scholar
  31. 31.
    Ruetten S, Komp M, Merk H, Godolias G (2008) Full-endoscopic interlaminar and transforaminal lumbar discectomy versus conventional microsurgical technique: a prospective, randomized, controlled study. Spine 33:931–939CrossRefPubMedGoogle Scholar
  32. 32.
    Rui Shan L et al (2016) Clinical effect analysis of percutaneous endoscopic lumbar discectomy for lumbar disc herniation. J Baotou Med Coll 32(7):49–50Google Scholar
  33. 33.
    Schoenfeld AJ (2011) Historical contributions from the Harvard system to adult spine surgery. Spine 36:E1477–E1484.  https://doi.org/10.1097/BRS.0b013e3181f2d52c CrossRefPubMedGoogle Scholar
  34. 34.
    Shicheng W, Lei P, Biliu H et al (2015) Comparative study on percutaneous transforaminal endoscopic discectomy and small incision method for lumbar disc herniation. J Pract Orthop 21(4):293–296Google Scholar
  35. 35.
    Stang A (2010) Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol 25:603–605CrossRefPubMedGoogle Scholar
  36. 36.
    Suri P, Pearson AM, Zhao W, Lurie J et al (2017) Pain recurrence after discectomy for symptomatic lumbar disc herniation. Spine (Phila Pa 1976) 42(10):755–763CrossRefGoogle Scholar
  37. 37.
    Tang G, Huang Q, Zhang W (2012) Preliminary outcomes of percutaneous transformational endoscopic lumbar discectomy for elder patients with lumbar disc herniation. China J Endosc 18(12):1300–1303Google Scholar
  38. 38.
    Tao Zhi Qiang et al (2016) Comparison of outcomes of percutaneous transforaminal endoscopic discectomy versus fenestration discectomy for lumbar disc herniation. Jiangxi Med J 51(1):32–33,49Google Scholar
  39. 39.
    Wang H, Huang B, Li C (2013) Learning curve for percutaneous endoscopic lumbar discectomy depending on the surgeon’s training level of minimally invasive spine surgery. Clin Neurol Neurosurg 115:1987–1991CrossRefPubMedGoogle Scholar
  40. 40.
    Weiguo D, Weixing X, Di L et al (2016) Efficacy of two surgical treatment of lumbar disc herniation: percutaneous transfouraminal endoscope discectomy (PTED) and fenestration discectomy. China J Endosc 22(4):43–48Google Scholar
  41. 41.
    Wu J, Ge B et al (2016) A comparison between intervertebral fenestration and percutaneous transforaminal endoscopic discectomy for treatment of lumbar disc herniation. Orthop J China Vol 24(21):1972–1976Google Scholar
  42. 42.
    Yeung A, Gore S (2014) Endoscopic foraminal decompression for failed back surgery syndrome under local anesthesia. Int J Spine Surg 1(8):2014.  https://doi.org/10.14444/1022 CrossRefGoogle Scholar
  43. 43.
    Zhang Y et al (2016) Comparison of Outcomes of percutaneous transforaminal endoscopic discectomy versus fenestration discectomy for Lumbar Disc Herniation. Mod J Integr Tradit Chin West Med 25(1):87–89Google Scholar
  44. 44.
    Zhimin P, Yoon H et al (2016) Efficacy of Transforaminal Endoscopic Spine System (TESSYS) technique in treating lumbar disc herniation. Med Sci Monit 22:530–539CrossRefGoogle Scholar

Copyright information

© Springer Medizin Verlag GmbH, ein Teil von Springer Nature 2018

Authors and Affiliations

  1. 1.Department of OrthopedicsChangzhou Second People’s Hospital, Nanjing Medical UniversityChangzhouChina

Personalised recommendations