Percutaneous Endoscopic Lumbar Discectomy Versus Microdiscectomy for the Treatment of Lumbar Disc Herniation: Pain, Disability, and Complication Rate—A Randomized Clinical Trial

Meyer, Guilherme Pereira Corrêa; Rocha, Ivan Dias da; Cristante, Alexandre Fogaça; Marcon, Raphael Martus; Coutinho, Thiago; Torelli, Alessandro Gonzalez; Petersen, Pedro Araújo; Letaif, Olavo Biraghi; Filho, Tarcísio Eloy Pessoa de Barros

doi:10.14444/7010

Cited by 25 publications

(20 citation statements)

References 30 publications

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“…A total of 38 articles qualified for full-text review of which 11 were excluded. Finally, 27 studies, including 11 RCTs, [15][16][17][18][19][20][21][22][23][24][25] 7 nonrandomized prospective studies, [26][27][28][29][30][31][32] and 9 retrospective studies [33][34][35][36][37][38][39][40][41] with a total of 4018 patients were included in our analysis. List of studies excluded from full-text review is given in the Supplementary File 1.…”

Section: Search Resultsmentioning

confidence: 99%

“…Barber et al 45 in their meta-analysis comparing the outcomes of ED with MD from 26 studies noted similar findings as that of our study but they failed to analyze the duration of surgery and their functional outcomes based on MacNab classification. Moreover, our analysis included 3 more studies 22,29,34 published after their analysis, which added to the number and quality of the evidence synthesized from our study with 1085 additional patients.…”

Section: Discussionmentioning

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: Search Resultsmentioning

confidence: 99%

Section: Discussionmentioning

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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“…Since the paravertebral muscles are not shortened, they shrink and are badly weakened as a result. [22] On longer follow-up, endoscopic and microscopic discectomies are similarly secure and reliable procedures for lumbar disc removal. However, because of early mobilization and less postoperative discomfort, endoscopic discectomy was found to be superior to traditional discectomy in terms of short-term outcomes.…”

Section: Discussionmentioning

confidence: 99%

Endoscopic Microdiscectomy Versus Conventional Discectomy for Lumber Disc Diseases; A Randomized Controlled Trial at Tertiary Care Hospital

Ujjan¹,

Nawaz²,

Khalil³

et al. 2022

PJMHS

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Objective: The aim of this study is to determine the efficacy of endoscopic microdisectomy versus conventional discectomy for lumber disc disease. Study Design: Randomized Control trial Place and Duration: Dow International Medical College and Hospital OJHA Campus, Karachi during the period from December, 2021 to May, 2022. Methods: Total 70 patients of both genders were presented in this study. Patients detailed demographics age, sex and BMI were recorded after taking written consent. Patients were aged between 18-70 years, Patients were divided in to two groups I and II. Group I had 35 patients and underwent for endoscopic microdisectomy and group II received conventional discectomy among 35 patients. The research included patients with low back pain radiating to the legs and prolapsed intervertebral discs at the L5–S1 and L4–L5 levels on MRI. Post-operatively effectiveness was observed between both groups, by using Oswestry disability index (ODI) in follow up of 10 months. Complete data was analyzed by SPSS. Results: Total 34 (48.6%) patients were females and 36 (51.4%) were males. Mean age of the patients were 48.32± 6.44 years with mean BMI 26.14± 3.23 kg/m2. Significantly no difference was observed between age and BMI. Patients who had prolapsed disc at L4-5 levels were 26 (37.14%) and 44 (62.86%) patients had prolapsed disc at L5-S1. Mean post-operative ODI in group I was 21.14± 54 and in group II was 24.16± 3.31. Mean post-operative vas in group I was 3.5 and in group II was 5.7. In group I hospital stay, blood loss and complications were observed less as compared to group II. Conclusion: We concluded in this that both endoscopic microdisectomy and conventional discectomy was effective and safe procedures. But conventional discectomy was found less effective as compared to endoscopic microdisectomy in terms of rapid mobilization and postoperative pain. Keywords: Oswestry Disability Index (ODI), Lumbar Disc Prolapse, Endoscopic Discectomy, Visual Analog Score (VAS)

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“…Among the various endoscopic spine surgery techniques, only the TELD technique has been proven by randomized controlled trials (RCTs) [21][22][23][24][25][26][27] and systematic reviews with meta-analyses. [28][29][30][31] Mayer and Brock 23 first performed an RCT comparing the clinical outcomes of TELD and open lumbar microdiscectomy.…”

Section: Evidencementioning

confidence: 99%

Transforaminal Endoscopic Lumbar Discectomy: Basic Concepts and Technical Keys to Clinical Success

Lee

Ahn

2021

Int J Spine Surg

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Background: Open microdiscectomy is the gold standard surgical technique for radiculopathy with lumbar disc herniation (LDH). Transforaminal endoscopic lumbar discectomy (TELD) has been developed as an effective and minimally invasive alternative to open surgery. As a result of these remarkable technical evolutions, the clinical outcomes of TELD have become comparable to those of conventional open surgery. However, considerable learning curves and endoscopy-related adverse events may emerge as critical problems.Objective: The objective of this article was to inform on the basic principles, surgical techniques, and keys to clinical success in preventing complications.Methods: A narrative review of the literature focused on the surgical indications, technical tips, complications, and learning curve of the full-endoscopic procedure was performed.Results: First, the transforaminal endoscopic system should access as close as possible to the target point, avoiding exiting nerve root irritation. Second, selective removal of the herniated disc fragments after sufficiently releasing the annular anchorage parts is essential to avoid incomplete decompression or prevent an early recurrence. Third, the endpoint of the procedure can be determined at the point of solid pulsation and free mobilization of the nerve root. Finally, surgeons should always ensure that the anatomical layers discriminate the neural tissue and disc material during the procedure. Some authors have demonstrated the effectiveness of TELD through randomized controlled trials, meta-analyses, and systemic reviews. According to these studies, the clinical outcomes of TELD are not inferior to those of open discectomy, with an earlier recovery period and fewer complications.Conclusions: The full-endoscopic transforaminal discectomy technique for soft LDH is an effective alternative with the benefits of minimally invasive surgery in appropriately selected patients. Given recent technical developments, the surgical indications for TELD will be broader and the clinical outcomes will be more reliable.

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Percutaneous Endoscopic Lumbar Discectomy Versus Microdiscectomy for the Treatment of Lumbar Disc Herniation: Pain, Disability, and Complication Rate—A Randomized Clinical Trial

Cited by 25 publications

References 30 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

Endoscopic Microdiscectomy Versus Conventional Discectomy for Lumber Disc Diseases; A Randomized Controlled Trial at Tertiary Care Hospital

Transforaminal Endoscopic Lumbar Discectomy: Basic Concepts and Technical Keys to Clinical Success

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