Percutaneous endoscopic transforaminal discectomy precedes interlaminar discectomy in the efficacy and safety for lumbar disc herniation

Abstract

We searched several databases from the times of their inception to 20 December 2018. Randomized controlled trials and cohort studies that compared percutaneous endoscopic transforaminal discectomy (PETD) with percutaneous endoscopic interlaminar discectomy (PEID) were identified. We used a random-effects model to calculate the relative risks (RRs) of, and standardized mean differences (SMDs) between the two techniques, with 95% confidence intervals (CIs). Twenty-six studies with 3294 patients were included in the final analysis. Compared with PEID, PETD reduced the short-term (SMD −0.68; 95% CI −1.01, −0.34; P=0.000) and long-term (SMD −0.47; 95% CI −0.82, −0.12; P=0.000) visual analog scale scores, blood loss (SMD −4.75; 95% CI −5.80, −3.71; P=0.000), duration of hospital stay (SMD −1.86; 95% CI −2.36, −1.37; P=0.000), and length of incision (SMD −3.93; 95% CI −5.23, −2.62; P=0.000). However, PEID was associated with a lower recurrence rate (P=0.035) and a shorter operative time (P=0.014). PETD and PEID afforded comparable excellent- and good-quality data, long- and short-term Oswestry disability index (ODI) scores, and complication rates. PETD treated lumbar disc herniation (LDH) more effectively than PEID. Although PETD required a longer operative time, PETD was as safe as PEID, and was associated with less blood loss, a shorter hospital stay, and a shorter incision. PETD is the best option for patients with LDH.

Percutaneous Endoscopic Transforaminal Discectomy with Foraminoplasty in the Treatment of L4-L5 and L5-S1 Disc Herniation: A Minimum 1-year Follow-up Study.

“…The clinical outcomes of PETDF recorded in this study were similar to ndings reported in previous studies [12][13][14] . Analysis showed signi cant improvements in pain score and functional status of all patients during the nal follow-up.…”

Endoscopic removal of nucleus pulposus of intervertebral disc on lumbar intervertebral disc protrusion and the influence on inflammatory factors and immune function

“…These indicators are related to surgical safety. Chen et al (19) indicated that percutaneous endoscopic discectomy had better safety and was associated with less blood loss, shorter hospital stays, and short incision, and was the best choice for patients with LIDP. Pan et al (20) also compared endoscopic lumbar discectomy with traditional lumbar discectomy in patients with LIDP.…”

A Review of Full-endoscopic Interlaminar Discectomy for Lumbar Disc Disease: A Historical and Technical Overview

“…The results showed that although the two approaches have no statistical difference in various clinical outcome scores, recovery time and recurrence rate, TELD has advantages in reducing postoperative complications, and IELD has advantages in reducing intraoperative bleeding, shortening the time of fluoroscopy and operation. A recent meta-analysis study in a series of 3294 patients to compare the efficacy of TELD with IELD, it showed that the visual analog scale scores are lower than IELD, and the author described that the visual analog scale scores reduction is related to the thoroughness of herniation treatment and to the extent of surgical damage 52) . We typically think about IELD shows advantages in avoiding the approach barrier of iliac crest level compared to transforaminal approach; however, choi reported that the decision of surgical approach for L5/S1 not depends on the height of intervertebral disc and iliac crest, it is statistically related to the location and the type of the disc herniation as well as the high-grade migration 34) .…”