Discectomy Combined with Annulus Fibrosus Repair for the Treatment of Lumbar Disc Herniation: A Bayesian analysis of Random Controlled Trials

Abstract

Objective To investigate clinical effects of discectomy combined with annulus fibrosus (AF) repair for the treatment of lumbar disc herniation. Methods We searched PubMed, Embase, Web of Science, CNKI and WanFang data for studies evaluating discectomy combined with AF repair and discectomy for the treatment lumbar disc herniation. Two reviewers selected studies, assessed quality, and extracted data. This meta-analysis was performed to calculate the weighted mean difference (WMD), risk ratios (RRs), and 95% confidence intervals (CIs). Results Six randomized controlled trials (RCTs) were included in the meta-analysis. The pooled results suggested that the recurrence rate and reoperation rate in the non-repair group versus those in the repair group [RR= 2.64, 95% confidence interval (CI) 1.09, 6.41], [RR=1.33, CI 0.85, 2.10], respectively. The rate of Visual analogue scale (VAS) relief in the repair group was significantly better than in non-repair group [WMD=0.23, CI 0.04, 0.42], and did not increase the incidence of postoperative complications. There were no significant differences between the two surgical procedures in the Oswestry disability index (ODI) reduction [WMD=-0.18, CI -1.50, 1.14], intraoperative blood loss [WMD = -1.23, CI -4.46, 2.00] and the length of the surgical incision [WMD = 0.08, CI -0.01, 0.18]. However, the operation time of the repair group was slightly longer than non-repair group [WMD =6.73, CI 2.80, 10.66]. Conclusion Discectomy combined with AF repair is superior to discectomy regarding postoperative recurrence rate and postoperative pain relief, but the operation time is slightly longer than the latter. There is no significant difference in reoperation rate, intraoperative blood loss, length of the surgical incision, postoperative complication rate, and reduction in ODI between the two surgical procedures.