Is It Possible to Replace Microendoscopic Discectomy with Percutaneous Transforaminal Discectomy for Treatment of Lumbar Disc Herniation? A Meta-Analysis Based on Recurrence and Revision Rate

Zhao, Xiaoming; Yuan, Qiling; Liu, Liang; Shi, Yaming; Zhang, Yingang

doi:10.3340/jkns.2019.0229

Cited by 7 publications

(6 citation statements)

References 32 publications

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“…Another widely used technique is percutaneous endoscopic transforaminal discectomy. Compared with MD, the instrument operation of this technique is difficult, the learning curve is steep, and it is difficult to deal with the upward or downward separation of intervertebral disc tissue, and the postoperative recurrence rate is higher than that of MD [7–9] . The development of the new technique of unilateral biportal endoscopy (UBE) has solved the problems of narrow channel and limited instruments during single-hole endoscopy and microsurgical decompression.…”

Section: Introductionmentioning

confidence: 99%

“…Compared with MD, the instrument operation of this technique is difficult, the learning curve is steep, and it is difficult to deal with the upward or downward separation of intervertebral disc tissue, and the postoperative recurrence rate is higher than that of MD. [7][8][9] The development of the new technique of unilateral biportal endoscopy (UBE) has solved the problems of narrow channel and limited instruments during single-hole endoscopy and microsurgical decompression. UBE uses water as a medium like a singlechannel endoscope, and continuous water irrigation can ensure the clarity of the surgical field.…”

Section: Introductionmentioning

confidence: 99%

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Efficacy and safety of unilateral biportal endoscopy compared with microscopic decompression in the treatment of lumbar spinal stenosis

et al. 2021

Medicine

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Objective: Systematic evaluation of the efficacy and safety of unilateral biportal endoscopic decompression in the treatment of lumbar spinal stenosis. Methods: We conducted a systematic literature search and compared the randomized controlled trials (RCTs) and retrospective studies of unilateral biportal endoscopy (UBE) and microscopic decompression (MD) in the treatment of lumbar spinal stenosis from several databases. Results: Seven studies were included. The results of meta-analysis showed that the operation time of UBE was shorter than that of MD. [SMD = −0.443, 95% CI (−0.717, −0.169), P = .002]. Compared with MD, the patients’ back pain was slighter on the 1st day, 1–2 months and 6 months after UBE. During the long-term follow-up, there was no significant difference in back pain between MD and UBE [SMD = −0.519, 95% CI (−0.934, −0.104), P = .014]. There was no significant difference in lower limb visual analogue score (VAS) score between UBE decompression and MD [SMD = −0.105, 95% CI (−0.356, 0.146), P = .412]. The results of meta-analysis showed that the C-reactive protein (CRP) level of UBE was lower than that of MD [weighted mean difference = −1.437, 95% CI (−2.347, −0.527), P = .002]. There was no significant difference in other clinical effects between the 2 groups. Conclusion: The operation time of UBE was shorter than that of MD, and it was superior to micro decompression in early back VAS score, lower limb VAS score and early postoperative CRP level. There was no statistical difference between UBE and MD in other outcomes.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Efficacy and safety of unilateral biportal endoscopy compared with microscopic decompression in the treatment of lumbar spinal stenosis

et al. 2021

Medicine

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“…Although several meta-analyses comparing the outcomes of FED with those of MED have already been reported, findings regarding the complications and recurrence rates remain controversial. [14][15][16][17][18][19][20] The previous comparative studies between MED and FED involved different types and vertebral levels of LDH. 5,6,[21][22][23][24] Depending on the type and level of LDH, the treatment strategy differs.…”

Section: Discussionmentioning

confidence: 99%

Comparison of the Outcomes of Microendoscopic Discectomy Versus Full-Endoscopic Discectomy for the Treatment of L4/5 Lumbar Disc Herniation

Fujita

Inui

Oshima

et al. 2022

Global Spine Journal

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Study Design Retrospective Comparative Study. Objectives To compare the outcomes of microendoscopic discectomy (MED) versus full-endoscopic discectomy (FED) for treating L4/5 lumbar disc herniation (LDH). Methods A retrospective study was performed on patients with L4/5 LDH treated using MED (n = 249) or FED (n = 124). A 16-mm tubular retractor and endoscope was used for MED, while a 4.1-mm working channel endoscope was used for FED. Patient background and operative data were collected. The Oswestry Disability Index (ODI) and European Quality of Life-5 Dimensions (EQ-5D) scores were recorded preoperatively and at 1 and 2 years postsurgery. Results The background data of the two groups were similar. The mean operation times for MED and FED were 59.3 and 47.7 min (respectively), and the mean volumes of removed nucleus pulposus were .65 and 1.03 g, respectively. These differences were significant ( P < .001). Six dural tears and one postoperative hematoma were observed in the MED group; none were observed in the FED group. During the follow-up period, 16 MED and 7 FED patients required re-operation due to recurrence ( P = 1.00). Although the ODI and EQ-5D scores significantly improved at 1 and 2 years postsurgery in both groups, the differences were not statistically significant. Conclusions Operative outcomes were almost identical in both groups. We did not observe any operative or postoperative complications in FED. We, therefore, recommend FED as the first option for the treatment of L4/5 LDH since it has a better safety profile and is minimally invasive.

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“…Among such studies, Zhao et al indicated that FED-TFA has a number of advantages owing to its minimally invasive nature, but subsequent recurrence and revision rates are higher than those of MED (12 studies: 1048 patients in the FED group and 1352 patients in the MED group). Zhao et al concluded that MED should not be completely replaced by TFA-FED [ 19 ]. Although Xu et al performed a similar meta-analysis (nine studies: 468 patients in the FED group and 516 patients in the MED group), no differences in leg pain were found, although lower back pain in the FED group was lesser than that in the MED group 24 months after surgery [ 20 ].…”

Section: Discussionmentioning

confidence: 99%

Comparative Study between Full-Endoscopic Discectomy and Microendoscopic Discectomy for the Treatment of Lumbar Disc Herniation

et al. 2020

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Background and objectives: Lumbar disc herniation (LDH) is a common disease in the meridian of life. Although surgical discectomy is commonly used to treat LDH, there are several different strategies. We compared the outcomes of uniportal full-endoscopic discectomy (FED) with those of microendoscopic discectomy (MED) in treating LDH. Materials and Methods: FED was performed using a 4.1-mm working channel endoscope, and MED was performed using a 16-mm diameter tubular retractor and endoscope. Data of patients with LDH treated with FED (n = 39) or MED (n = 27) by the single surgeon were retrospectively reviewed. Patient background information and operative data were collected. Pre- and postoperative low back and leg pain were evaluated using the numerical rating scale (NRS) score. Pre- and postoperative disc height index (DHI) values were calculated from plain radiographs, and the disc height loss was evaluated using the ratio (DHI ratio); Results: The median (interquartile range (IQR) Q25–75) operation times for FED and MED were 42 (33–61) and 43 (33–50) minutes, respectively. The median (IQR Q25–75) pre- and postoperative NRS scores for low back pain were 5 (2–7) and 1 (0–4), respectively, for FED and 6 (3–8) and 1 (0–2), respectively, for MED. The median (IQR Q25–75) pre- and postoperative NRS scores for leg pain were 7 (5–8) and 0 (0–2), respectively, for FED and 6 (5–8) and 0 (0–2), respectively, for MED. These data were not different between the FED and MED groups. The median (IQR Q25–75) DHI ratios of FED and MED were 0.94 (0.89–1.03) and 0.90 (0.79–0.95), respectively. The DHI ratio was significantly higher (p < 0.05) in the FED group than in the MED group, and there was less blood loss; Conclusions: The pain-relieving effect of FED in treating LDH was almost identical to that of MED. However, FED was superior to MED in preventing disc height loss, which is one of the indicators of postoperative disc degeneration.

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Is It Possible to Replace Microendoscopic Discectomy with Percutaneous Transforaminal Discectomy for Treatment of Lumbar Disc Herniation? A Meta-Analysis Based on Recurrence and Revision Rate

Cited by 7 publications

References 32 publications

Efficacy and safety of unilateral biportal endoscopy compared with microscopic decompression in the treatment of lumbar spinal stenosis

Efficacy and safety of unilateral biportal endoscopy compared with microscopic decompression in the treatment of lumbar spinal stenosis

Comparison of the Outcomes of Microendoscopic Discectomy Versus Full-Endoscopic Discectomy for the Treatment of L4/5 Lumbar Disc Herniation

Comparative Study between Full-Endoscopic Discectomy and Microendoscopic Discectomy for the Treatment of Lumbar Disc Herniation

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