Systematic review of microendoscopic discectomy for lumbar disc herniation
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To search and analyse randomised controlled trials (RCTs) published since the Cochrane review by Gibson and Waddell (2007) comparing microendoscopic discectomy (MED) with open discectomy (OD) or microdiscectomy (MD) and to assess whether MED improves patient-reported outcomes.
Summary of background
Discectomy for symptomatic herniated lumbar discs is an effective operative treatment. A number of operative techniques exist including OD, MD, and MED. A 2007 Cochrane review identified OD as an effective treatment for symptom improvement, and found sufficient evidence for MD. However, evidence for MED was lacking.
A systematic review of Medline and Embase was carried out. Aiming to identify RCTs carried out after 2007, which compared OD with MD and MED which reported the Oswestry disability index (ODI) as an outcome.
Four RCTs were identified. None of the studies found a significant difference in the ODI scores between study groups at any time point. Three studies compared MED to OD and one compared OD, MD, and MED. The largest study reported an increased number of severe complications in the MED group.
There is some evidence to suggest that MED performed by surgeons skilled in the technique in tertiary referral centres is as effective as OD.
KeywordsMicroendoscopic discectomy Lumbar disc herniation Sciatica Discectomy
Conflict of interest
- 4.Gibson JN, Waddell G (2007) Surgical interventions for lumbar disc prolapse. Cochrane Database Syst Rev 2: CD001350Google Scholar
- 5.Foley KT, Smith MM (1997) Micro endoscopic discectomy. Op Neurosurg 3:301–307Google Scholar
- 7.Bragge P (2010) Asking good clinical research questions and choosing the right study design. Injury Supp1(1): S3–S6Google Scholar
- 8.Schulz KF, Altman DG, Moher D (2010) CONSORT 2010 Statement: updated guidelines for reporting parallel group randomised trials. BMC Med 8(18)Google Scholar
- 10.Liu WG, Wu XT, Guo JH, Zhuang SY, Teng GJ (2010) Long-term outcomes of patients with lumbar disc herniation treated with percutaneous discectomy: comparative study with micro endoscopic discectomy. Cardiovasc Intervent Radiol 33(8003538, com): 780–6Google Scholar
- 12.Zhang C, Zhou Y, Chu TW, Wang J, Hao Y, Pan Y (2007) Microendoscopic discectomy, a less traumatic procedure for lumbar disk herniation. Chin J Traumatol 10(5):311–314Google Scholar
- 14.Ruetten S, Komp M, Merk H, Godolias G (2009) Recurrent lumbar disc herniation after conventional discectomy: a prospective, randomized study comparing full-endoscopic interlaminar and transforaminal versus microsurgical revision. J Disord 22(101140323):122–129Google Scholar
- 15.Righesso O, Falavigna A, Avanzi O (2007) Comparison of open discectomy with microendoscopic discectomy in lumbar disc herniations: results of a randomized controlled trial. Neurosurg 61(nzl, 7802914): 545–549Google Scholar
- 16.Teli M, Lovi A, Brayda-Bruno M, Zagra A, Corriero A, Giudici F, et al (2010) Higher risk of dural tears and recurrent herniation with lumbar micro-endoscopic discectomy. Eur Spine J 19(9301980, b9y): 443–450Google Scholar
- 17.Garg B, Nagraja UB, Jayaswal A (2011) Microendoscopic versus open discectomy for lumbar disc herniation: a prospective randomised study. J Orthop Surg (Hong Kong) 19(9440382, 101265112): 30–4Google Scholar
- 18.Nakagawa H, Yoshida M, Maia K (2006) Microendoscopic discectomy (MED) for surgical management of lumbar disc disease: technical note. J Spine Surg 2(2)Google Scholar