Complication rates of different discectomy techniques for the treatment of lumbar disc herniation: a network meta-analysis

Chen, Xiaolong; Chamoli, Uphar; Lapkin, Samuel; Castillo, Jose Vargas; Diwan, Ashish D.

doi:10.1007/s00586-019-06142-7

Cited by 39 publications

(23 citation statements)

References 57 publications

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“…Chen et al 46 did a network meta-analysis on the complication rates of different discectomy techniques for the management of lumbar disc herniation. In their analysis, they found that both MD and ED were the safest of other procedures for lumbar discectomy like tubular discectomy or percutaneous laser disc decompression.…”

Section: Main Findingsmentioning

confidence: 99%

“…Since the gold standard MD procedure involves partial resection of ligamentum flavum and lamina with retraction of dura and root, chances of complications like a dural tear, dysesthesia and infection were found to be higher in MD compared with ED. 46 Besides, the problems due to epidural scar and hematoma need to be solved along with postoperative lumbar instability. 47 On the other hand, with the advances in endoscopic devices with greater maneuverability, the incidence of such complications are limited in ED.…”

Section: Main Findingsmentioning

confidence: 99%

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Is Endoscopic Discectomy the Next Gold Standard in the Management of Lumbar Disc Disease? Systematic Review and Superiority Analysis

Muthu

Ramakrishnan

Chellamuthu

2020

Global Spine Journal

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Study Design: Systematic review and meta-analysis. Objectives: We performed this meta-analysis to evaluate whether endoscopic discectomy (ED) shows superiority compared with the current gold standard of microdiscectomy (MD) in management of lumbar disc disease. Materials and Methods: We conducted independent and duplicate electronic database search including PubMed, Embase, and Cochrane Library from 1990 till April 2020 for studies comparing ED and MD in the management of lumbar disc disease. Analysis was performed in R platform using OpenMeta[Analyst] software. Results: We included 27 studies, including 11 randomized controlled trials (RCTs), 7 nonrandomized prospective, and 9 retrospective studies involving 4018 patients in the meta-analysis. We stratified the results based on the study design. Considering the heterogeneity in some results between study designs, we weighed our conclusion essentially based on results of RCTs. On analyzing the RCTs, superiority was established at 95% confidence interval for ED compared with MD in terms of functional outcomes like Oswestry Disability Index (ODI) score ( P = .008), duration of surgery ( P = .023), and length of hospital stay ( P < .001) although significant heterogeneity was noted. Similarly, noninferiority to MD was established by ED in other outcomes like visual analogue scale score for back pain ( P = .860) and leg pain ( P = .495), MacNab classification ( P = .097), recurrences ( P = .993), reoperations ( P = .740), and return-to-work period ( P = .748). Conclusion: Our meta-analysis established the superiority of endoscopic discectomy in outcome measures like ODI score, duration of surgery, overall complications, length of hospital stay and noninferiority in other measures analyzed. With recent advances in the field of ED, the procedure has the potential to take over the place of MD as the gold standard of care in management of lumbar disc disease.

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Section: Main Findingsmentioning

confidence: 99%

Section: Main Findingsmentioning

confidence: 99%

Is Endoscopic Discectomy the Next Gold Standard in the Management of Lumbar Disc Disease? Systematic Review and Superiority Analysis

Muthu

Ramakrishnan

Chellamuthu

2020

Global Spine Journal

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“…These methods have obvious advantages of minor tissues injury, less blood loss, fewer scars and faster recovery due to early postoperative pain relief. However, incomplete removing the nucleus pulposus, LDH recurrence or FBSS about these methods are inevitable [9] [ 10] . The LDH recurrence rate about discectomy is about 15%, and this rate increases with the observation time going longer [11] .…”

Section: Discussionmentioning

confidence: 99%

Clinical Study of Unilateral Extraforaminal Lumbar Interbody Fusion (ELIF) Revision For Lumbar Disc Herniation After Primary Discectomy

Tang²,

Chen³

et al. 2021

Preprint

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Background: Lumbar disc herniation (LDH) is a common spinal disorder. The discectomy with non-fusion operation is widely used. When the revision is needed, the options for revision way is still controversial. This study aims to introduce unilateral extraforaminal lumbar interbody fusion (ELIF) revision surgery, and to investigate the clinical efficacy and complication of Unilateral Extraforaminal Lumbar Interbody Fusion (ELIF) in revising primary discectomy for lumbar disc herniation. Methods:16 patients with incomplete removal and recurrence herniation of lumbar disc after minimally invasive treatment without fixation were treated by ELIF with unilateral pedicle screw(UPS) from April 2016 to October 2020. All those patietns including 11 male and 5 female aged 29-65 years were analyzed retrospectively. The clinical effects were evaluated by operation time, intraoperative blood loss, postoperative blood volume of drainage and complications. The Visual Analogue Scale(VAS), Oswestry Disability Index (ODI) were documented before, after surgery and at last follow--up. Results: The operation time was 95.73±10.5 min, the bleeding volume was 201.5±27.6 ml. Postoperative blood volume of drainage was 50.7±6.3 ml. 2 patients suffered dura tear. All patients were followed up for 12-26 months with 15.7 on average. VAS and ODI scores significantly improved at the preoperative, postoperative and the 12th month’s follow up (P < 0.05). Conclusion: The application of ELIF with unilateral fixation is a satisfied way to revise primary discectomy for lumbar disc herniation. However, the dura tear induced by scar tissue adhesion needs to be noticed.

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“…Dural tear and nerve injury have been reported with an incidence of 0% to 5.6% and 0% to 1.5%, respectively, in lumbar endoscopic procedures [ 18 - 20 ]. The former can go unnoticed, presenting symptoms of intracranial hypotension in the postoperative period.…”

Section: Discussionmentioning

confidence: 99%

Transforaminal Endoscopic Thoracic Discectomy: Technical Review to Prevent Complications

Choi

Muñoz-Suárez

2020

Neurospine

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For all the spine surgeons, thoracic disc herniations (TDHs) entrust a real challenge in terms of patient diagnosis, proper selection, surgical technique, and potential adverse events. TDHs are relatively uncommon compared to the lumbar and cervical levels. Literature reports a variable prevalence of TDHs around 6% to 40%, but less than 1% of all disk herniations are symptomatic TDHs, evidencing as a relatively unusual condition. Nowadays, transforaminal endoscopic thoracic discectomy (TETD) has been implemented as an alternative to classic open procedures with results that are as good as and, in some situations, better than those in traditional discectomy. However, the surgeon must be familiar with endoscopic lumbar spine surgery before opting to perform a TETD, considering that the learning curve is much harder. We describe all the steps and safety considerations during TETD based on the anatomic differences compared to lumbar endoscopic procedures. TETD is an effective and safe method that yields more benefits, provides a direct route to the lesion with less morbidity, and is performed in a minimally invasive way. Many severe complications related to the thoracic region could be avoided having the proper knowledge, adequate technique, and safety routes and considerations.

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Complication rates of different discectomy techniques for the treatment of lumbar disc herniation: a network meta-analysis

Cited by 39 publications

References 57 publications

Is Endoscopic Discectomy the Next Gold Standard in the Management of Lumbar Disc Disease? Systematic Review and Superiority Analysis

Is Endoscopic Discectomy the Next Gold Standard in the Management of Lumbar Disc Disease? Systematic Review and Superiority Analysis

Clinical Study of Unilateral Extraforaminal Lumbar Interbody Fusion (ELIF) Revision For Lumbar Disc Herniation After Primary Discectomy

Transforaminal Endoscopic Thoracic Discectomy: Technical Review to Prevent Complications

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