Comparison of percutaneous endoscopic lumbar discectomy versus microendoscopic discectomy for the treatment of lumbar disc herniation: a meta-analysis
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We conducted a systematic review and meta-analysis to compare the clinical outcomes of percutaneous endoscopic lumbar discectomy (PELD) and microendoscopic discectomy (MED) for the treatment of lumbar disc herniation (LDH), and to clarify whether PELD is more superior to MED.
We performed a comprehensive search in the databases of MEDLINE, EMBASE, PubMed, Web of Science, Cochrane database, CNKI, and Wanfang Data to acquire all relevant studies up to July 2018. The searched literatures were then screened according to the strict inclusion and exclusion criteria. The critical data were extracted and analyzed utilizing Review Manager software. The pooled effects were calculated by mean difference (MD) or odds ratio (OR) with 95% confidence intervals (CI) on the basis of data attributes.
A total of 18 studies (2161 patients, 1093 in the PELD group and 1068 in the MED group) were included in this systematic review and meta-analysis. At last follow-up, the results revealed that no significant difference was found between PELD group and MED group with respect to ODI (MD − 0.30; 95% CI − 1.02 to 0.42; P = 0.41), VAS-leg pain (MD − 0.18; 95% CI − 0.45 to 0.09; P = 0.19), VAS-unspecified (MD − 0.00; 95% CI − 0.05 to 0.04; P = 0.94), excellent & good rate (OR, 1.04; 95% CI 0.68 to 1.59; P = 0.86), total complication rate (OR, 0.96; 95% CI 0.65 to 1.43; P = 0.85), dural tear rate (OR, 0.39; 95% CI 0.10 to 1.55; P = 0.18), and residue or recurrence rate (OR, 2.22; 95% CI 1.02 to 4.83; P = 0.05). When compared to MED group, the PELD group showed significantly better results with regard to shorter length of incision (MD − 1.18; 95% CI − 1.39 to − 0.97; P < 0.00001), less blood loss (MD − 45.17; 95% CI − 64.74 to − 25.60; P < 0.00001), shorter post-operative in-bed time (MD − 59.11; 95% CI − 71.19 to − 47.04; P < 0.00001), shorter post-operative hospital stay (MD − 3.07; 95% CI − 4.81 to − 1.33; P < 0.00001), shorter total hospital stay (MD − 2.29; 95% CI − 3.03 to − 1.55; P < 0.00001), and lower VAS-back pain at last follow-up (MD − 0.77; 95% CI − 1.31 to − 0.24; P = 0.005), but with significantly worse results such as more fluoroscopy (MD 7.63; 95% CI 5.25 to 10.01; P < 0.00001) and higher re-operation rate (OR, 2.67; 95% CI 1.07 to 6.67; P = 0.04). Although no significant difference was found between the two groups in terms of duration of operation (MD 6.27; 95% CI − 2.44 to 14.98; P = 0.16) and total hospital cost (MD − 0.69; 95% CI − 12.60 to 11.23; P = 0.91), further subgroup analysis revealed that the duration of operation was significantly longer in the PELD group compared with the MED group in “Years before 2016” (MD 24.97; 95% CI 7.07 to 42.87; P = 0.006) and “Year 2016 to 2017” (MD 6.57; 95% CI 0.58 to 12.55; P = 0.03) subgroups but not in the subgroup “Year 2018” (MD − 5.66; 95% CI − 18.84 to 7.53; P = 0.40), and that the total hospital cost was significantly more in the PELD group compared with the MED group in the subgroup “Southeast of China” (MD 6.67; 95% CI 3.23 to 10.28; P = 0.0002) but not in the subgroup “Midwest of China” (MD − 8.09; 95% CI − 17.99 to 1.80; P = 0.11).
For the treatment of LDH, both of PELD and MED can reach excellent results and no superiority was found between the two minimally invasive procedures with regard to duration of operation, ODI, VAS-leg pain, VAS-unspecified, excellent & good rate, total complication rate, dural tear rate, and residue or recurrence rate. While PELD can achieve better outcomes with respect to the length of incision, blood loss, post-operative in-bed time, post-operative hospital stay, total hospital stay, and VAS-back pain at last follow-up, however, MED showed certain advantages of less fluoroscopic times and lower re-operation rate. More practice and development are needed to make up for the deficiencies of PELD. Besides, the economic factor should also be considered according to different regions before making the treatment strategies. Well-defined randomized controlled trials with large samples are needed to further confirm these results.
KeywordsMinimally invasive surgery Percutaneous endoscopic lumbar discectomy Microendoscopic discectomy Lumbar disc herniation Treatment outcome
We would like to thank Dr. Chao Hu (The First Affiliated Hospital of Zhejiang University) and Dr. Jing-Jing Deng (Suzhou Center for Disease Control and Prevention) for their great help on the methodology. We also thank Dr. Sundar Karki (Medical School, Southeast University) for his great contribution on the language checking in this document.
This work was supported by grants from the National Natural Science Foundation of China (Grant Nos. 81702201, 81702203, 81572190, and 81572170) and the Natural Science Foundation of Jiangsu Province (CN): Grant No. BK20170701.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
- 1.Luo X, Pietrobon R, Sun SX, Liu GG, Hey L (2004) Estimates and patterns of direct health care expenditures among individuals with back pain in the United States. Spine (Phila Pa 1976) 29(1):79–86. https://doi.org/10.1097/01.BRS.0000105527.13866.0F CrossRefGoogle Scholar
- 5.Wu X, Zhuang S, Mao Z, Chen H (2006) Microendoscopic discectomy for lumbar disc herniation: surgical technique and outcome in 873 consecutive cases. Spine 31(23):2689–2694. https://doi.org/10.1097/01.brs.0000244615.43199.07 CrossRefGoogle Scholar
- 12.Sinkemani A, Hong X, Gao ZX, Zhuang SY, Jiang ZL, Zhang SD, Bao JP, Zhu L, Zhang P, Xie XH, Wang F, Wu XT (2015) Outcomes of microendoscopic discectomy and percutaneous transforaminal endoscopic discectomy for the treatment of lumbar disc herniation: a comparative retrospective study. Asian Spine J 9(6):833–840. https://doi.org/10.4184/asj.2015.9.6.833 CrossRefGoogle Scholar
- 16.Wu XC, Zhou Y, Li CQ (2009) Percutaneous transforaminal endoscopic discectomy versus microendoscopic discectomy for lumbar disc herniation: a prospective randomized controlled study. J Third Mil Med Univ 31(9):843–846. https://doi.org/10.3321/j.issn:1000-5404.2009.09.022 Google Scholar
- 17.Yoon SM, Ahn SS, Kim KH, Kim YD, Cho JH, Kim DH (2012) Comparative study of the outcomes of percutaneous endoscopic lumbar discectomy and microscopic lumbar discectomy using the tubular retractor system based on the VAS, ODI, and SF-36. Korean J Spine 9(3):215–222. https://doi.org/10.14245/kjs.2012.9.3.215 CrossRefGoogle Scholar
- 18.Yang L, Liao XQ, Zhao XJ, Zeng ZC, Wu RH, Guan HY, Li SY (2015) Comparison of surgical outcomes between percutaneous transforaminal endoscopic discectomy and micro-endoscopic discectomy for lumbar disc herniation. China J Endosc 21(09):962–965Google Scholar
- 19.Duan XF, Jin W, Chen JJ, Zheng HJ (2016) Jing pi Zhui Jian Pan Jing Xia Ji Jing Zhui Jian Kong Jing Xia sui he Zhai Chu Shu Zhi Liao Dan Chun Yao Zhui Jian Pan Tu Chu Zheng De dui Zhao guan cha (contrast observation of comparing microendoscopic discectomy with percutaneous endoscopic lumbar discectomy for the treatment of simple lumbar disc herniation). Chin J Clin (Electronic Edition) 10(1):144–147. https://doi.org/10.3877/cma.j.issn.1674-0785.2016.01.033 Google Scholar
- 21.Ding YZ, Hu JN, Zhou Y (2017) Jing Pi Zhui Jian Kong Jing Xia Xing TESSYS Ji Shu Yu Zhui Jian Pan Jing Xia Shou Shu Zhi Liao Yao Zhui Jian Pan Tu Chu Zheng De Xiao Guo Dui Bi (study on the effect contrast between microendoscopic discectomy and percutaneous endoscopic lumbar discectomy using TESSYS technique for the treatment of lumbar disc herniation). J Cervicodynia & Lumbodynia 38(5):492–493. https://doi.org/10.3969/j.issn.1005-7234.2017.05.002 Google Scholar
- 22.Li ZY, Guo PG, Han D, Hao JJ, Zhang GB (2017) Bu Tong Shou Shu Fang Shi Sui He Zhai Chu Shu Dui Yao Zhui Jian Pan Tu Chu Zheng Huan Zhe De Liao Xiao Ji Yu Hou Fen Xi (Analysis of curative effects and prognosis in different procedures of discectomy for patients with lumbar disc herniation). J Clin Med Pract 21(15):149–150,158. https://doi.org/10.7619/jcmp.201715048 Google Scholar
- 23.Liu HP, Hao DJ, Wang XD, Guo H, Zhao QP, Dong XH (2017) Comparison of two surgeries in treatment of lumbar disc herniation. Chin J Pain Med 23(6):438–442. https://doi.org/10.3969/j.issn.1006-9852.2017.06.008 Google Scholar
- 24.Luo DK, Zhou NX, Zhao HW, Chen K, Nie Y, Liu FP, Qin P (2017) Clinical effectiveness of minimally invasive treatment for lumbar disc herniation. Orthopaedics 8(6):439–444. https://doi.org/10.3969/j.issn.1674-8573.2017.06.005 Google Scholar
- 25.Qu JX, Li QZ, Chen M (2017) PELD Yu MED Zhi Liao Dan Jie Duan Yao Zhui Jian Pan Tu Chu Zheng De Liao Xiao Bi Jiao (Comparison of the efficacies between percutaneous transforaminal endoscopic discectomy and microendoscopic discectomy for the treatment of single-segmental lumbar disc herniation). Chin J Bone Jt Inj 32(01):70–71Google Scholar
- 27.Chen Q, Qin L, Li MW, Chen YN, Zhou CB (2018) Comparison of the therapeutic e ect of percutaneous transforaminal endoscopic discectomy and posterior discectomy on senile single segmental lumbar disc herniation. Chin J Front Med Sci (Electronic Version) 10(02):60–64Google Scholar
- 28.Wu YM, Bai M, Yin HP, Li Y, Zhao J (2018) Liang Zhong Wei Chuang Shu Shi Zhi Liao Dan Chun Yao Zhui Jian Pan Tu Chu Zheng De Liao Xiao Bi Jiao (Comparison of the efficacies between two kinds of minimally invasive procedures for the treatment of simple lumbar disc herniation). J Pract Orthop 24(04):357–360Google Scholar
- 29.Abudurexiti T, Qi L, Muheremu A, Amudong A (2018) Micro-endoscopic discectomy versus percutaneous endoscopic surgery for lumbar disk herniation. J Int Med Res 46(9):3910–3917. https://doi.org/10.1177/0300060518781694
- 30.Chen Z, Zhang L, Dong J, Xie P, Liu B, Wang Q, Chen R, Feng F, Yang B, Shu T, Li S, Yang Y, He L, Pang M, Rong L (2018) Percutaneous transforaminal endoscopic discectomy compared with microendoscopic discectomy for lumbar disc herniation: 1-year results of an ongoing randomized controlled trial. J Neurosurg Spine 28(3):300–310. https://doi.org/10.3171/2017.7.SPINE161434 CrossRefGoogle Scholar
- 32.Liu X, Yuan S, Tian Y, Wang L, Gong L, Zheng Y, Li J (2018) Comparison of percutaneous endoscopic transforaminal discectomy, microendoscopic discectomy, and microdiscectomy for symptomatic lumbar disc herniation: minimum 2-year follow-up results. J Neurosurg Spine 28(3):317–325. https://doi.org/10.3171/2017.6.SPINE172 CrossRefGoogle Scholar
- 34.Kim HS, Paudel B, Jang JS, Lee K, Oh SH, Jang IT (2018) Percutaneous endoscopic lumbar discectomy for all types of lumbar disc herniations (LDH) including severely difficult and extremely difficult LDH cases. Pain Physician 21(4):E401–e408Google Scholar
- 35.Xiaobing Z, Xingchen L, Honggang Z, Xiaoqiang C, Qidong Y, Haijun M, Hejun Y, Bisheng W (2018) “U” route transforaminal percutaneous endoscopic thoracic discectomy as a new treatment for thoracic spinal stenosis. Int Orthop. https://doi.org/10.1007/s00264-018-4145-y
- 37.Ding W, Yin J, Yan T, Nong L, Xu N (2018) Meta-analysis of percutaneous transforaminal endoscopic discectomy vs. fenestration discectomy in the treatment of lumbar disc herniation. Orthopade. https://doi.org/10.1007/s00132-018-3528-5
- 40.Parker S, Mendenhall S, Godil S, Sivasubramanian P, Cahill K, Ziewacz J, McGirt M (2015) Incidence of low back pain after lumbar discectomy for herniated disc and its effect on patient-reported outcomes. Clin Orthop Relat Res 473(6):1988–1999. https://doi.org/10.1007/s11999-015-4193-1 CrossRefGoogle Scholar
- 42.Hong X, Shi R, Wang YT, Liu L, Bao JP, Wu XT (2018) Lumbar disc herniation treated by microendoscopic discectomy: prognostic predictors of long-term postoperative outcome. Orthopade. https://doi.org/10.1007/s00132-018-3624-6
- 44.Yin S, Du H, Yang W, Duan C, Feng C, Tao H (2018) Prevalence of recurrent herniation following percutaneous endoscopic lumbar discectomy: a meta-analysis. Pain Physician 21(4):337–350Google Scholar
- 47.Matsumoto M, Watanabe K, Hosogane N, Tsuji T, Ishii K, Nakamura M, Chiba K, Toyama Y (2013) Recurrence of lumbar disc herniation after microendoscopic discectomy. J Neurol Surg A Cent Eur Neurosurg 74(4):222–227Google Scholar