Comparison of Three Common Intervertebral Disc Discectomies in the Treatment of Lumbar Disc Herniation: A Systematic Review and Meta-Analysis Based on Multiple Data

Abstract

Objective: Due to recent developments and the wide application of percutaneous transforaminal discectomy (PTED), we herein compare it with microendoscopic discectomy (MED) and traditional open surgery (OD) through surgical indicators and postoperative outcomes to evaluate the advantages and disadvantages of minimally invasive surgery PTED. Methods: This systematic review and meta-analysis was conducted in line with PRISMA guidelines (PROSPERO2018: CRD42018094890). We searched four English and two Chinese databases from the date of their establishment to May 2022. Randomized controlled trials and case–control studies of PTED versus MED or PTED versus OD in the treatment of lumbar disc herniation were retrieved. Results: A total of 33 studies with 6467 cases were included. When comparing MED with PTED, the latter had less intraoperative blood loss, smaller incision, shorter postoperative bed times, shorter hospitalization times, better postoperative visual analogue scale (VAS) for low back pain, and postoperative dysfunction index (Oswestry Disability Index, ODI) and higher recurrence rates and revision rates. However, operation times, postoperative VAS leg scores and complications, and successful operation rates were similar in both groups. Comparison of PTED with OD revealed in the former less intraoperative blood loss and smaller incision, shorter postoperative bed times, shorter hospitalization times, shorter operation times, and higher recurrence rates and revision rates. Nonetheless, comprehensive postoperative VAS scores, VAS leg pain scores, VAS low back pain, ODI and incidence of complications, and successful operation rates were similar between the two groups. Conclusions: The therapeutic effect and safety of PTED, MED and OD in the treatment of lumbar disc herniation were comparable. PTED had obvious advantages in that it is minimally invasive, with rapid recovery after surgery, but its recurrence rates and revision rates were higher than MED and OD. Therefore, it is not possible to blindly consider replacing MED and OD with PTED.

Predictive Factors for Residual Low Back Pain Following Percutaneous Endoscopic Lumbar Discectomy in Patients with Lumbar Disc Herniation

“…LDH is one of the most common diseases that cause LBP and LP, and for treatment, surgery should be considered if the patient does not respond to conservative therapy [ 20 ]. With the continuous improvement of surgical techniques and devices, PELD has gradually become one of the most widely used minimally invasive surgeries and can be used to treat various types of LDH at present [ 21 ].…”

C-arm Free Unilateral Biportal Endoscopic Discectomy: <strong></strong>A Technical Note

“…Among minimally invasive procedures, UBE and PELD had demonstrated comparable therapeutic effectiveness to conventional open surgeries in alleviating symptoms and enhancing functional abilities in LDH patients with less trauma and fast recovery [27,28]. But recent evidence indicated that patients underwent PELD may face a high risk of recurrence and revision rates in comparison to those treated with traditional open surgery and microdiscectomy [29]. Notably, the advancement of MISS in recent years had brought about the introduction of UBE with a lower LDH recurrence during follow-up compared to PLED [30].…”

The Three-Step Approach for Lumbar Disk Herniation with Anatomical Insights Tailored for the Next Generation of Young Spine Surgeons

“…Discectomy involves a small back incision to remove extruded disk material, relieving nerve pressure. While the primary goal of alleviating nerve impingement remains unchanged, newer methods focus on minimising trauma to the muscle and enhancing visualisation [ 5 , 6 ].…”