Abstract
Study design
Systematic review.
Objective
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.
Methods
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.
Results
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.
Conclusions
There is some evidence to suggest that MED performed by surgeons skilled in the technique in tertiary referral centres is as effective as OD.
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References
Valat JP, Genevay S, Marty M, Rozenberg S, Koes B (2010) Sciatica. Best Pract Res Clin Rheumatol 24:241–252
Weber H, Holme I, Amlie E (1993) The natural course of acute sciatica with nerve root symptoms in a double-blind placebo-controlled trial evaluating the effect of piroxicam. Spine 18:1433–1438
Vroomen PC, de Krom KM, Slofstra PD, Knottnerus JA (2000) Conservative treatment of sciatica: a systematic review. J Spinal Disord 13:463–469
Gibson JN, Waddell G (2007) Surgical interventions for lumbar disc prolapse. Cochrane Database Syst Rev 2: CD001350
Foley KT, Smith MM (1997) Micro endoscopic discectomy. Op Neurosurg 3:301–307
Huang TJ, Hsu RW, Li YY, Cheng CC (2005) Less systemic cytokine response in patients following micro endoscopic versus open lumbar discectomy. J Orthop Res 23(2):406–411
Bragge P (2010) Asking good clinical research questions and choosing the right study design. Injury Supp1(1): S3–S6
Schulz KF, Altman DG, Moher D (2010) CONSORT 2010 Statement: updated guidelines for reporting parallel group randomised trials. BMC Med 8(18)
Liu T, Zhou Y, Wang J, Chu TW, Li C, Zhang ZF et al (2012) Clinical efficacy of three different minimally invasive procedures for far lateral lumbar disc herniation. Chin Med J 125(6):1082–1088
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): 780–6
Shin D, Kim K, Shin H, Yoon D (2008) The efficacy of micro endoscopic discectomy in reducing iatrogenic muscle injury. J Neurosurg Spine 8(101223545):39–43
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):311–314
Arts MP, Brand R, Van Den Akker ME, Koes BW, Bartels RHMA, Peul WC (2009) Tubular diskectomy vs conventional microdiskectomy for sciatica: a randomized controlled trial. JAMA 302(2):149–158
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):122–129
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): 545–549
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): 443–450
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): 30–4
Nakagawa H, Yoshida M, Maia K (2006) Microendoscopic discectomy (MED) for surgical management of lumbar disc disease: technical note. J Spine Surg 2(2)
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Smith, N., Masters, J., Jensen, C. et al. Systematic review of microendoscopic discectomy for lumbar disc herniation. Eur Spine J 22, 2458–2465 (2013). https://doi.org/10.1007/s00586-013-2848-8
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DOI: https://doi.org/10.1007/s00586-013-2848-8