Dataset Information

Percutaneous Endoscopic Lumbar Discectomy for Recurrent Lumbar Disc Herniation: An Updated Systematic Review and Meta-Analysis.

ABSTRACT:

Objective

This meta-analysis evaluated surgical outcomes following endoscopic or conventional discectomy for recurrent lumbar disc herniation.

Methods

Medline, Cochrane, EMBASE, and Google Scholar were search until October 16, 2016 using these terms: recurrent lumbar disc herniation, endoscopic surgery, and discectomy. Randomized controlled trials (RCTs), prospective, retrospective, and cohort studies were eligible for inclusion. Pooled difference in mean (PDM) with 95% confidence interval (CIs) or relative risks (RRs) were calculated using fixed-effects methods.

Results

One RCT and 15 studies were included with a total of 820 patients. Patients received endoscopic surgery experienced shorter operation time than those received conventional surgery (PDM: -52.01, 95% CI: -76.84 to -27.18, P < 0.001). A significantly lower risk in complication was displayed in patients received endoscopic surgery compared to those received conventional surgery (RR: 0.209, 95% CI: 0.076-0.581, P = 0.003). No significant difference in the improvement in VAS (PDM: -2.19, 95% CI: -5.78 to 1.39, P = 0.231), length of stay (PDM: -6.44, 95% CI: -13.76 to 0.89, P = 0.085) and re-recurrence rate (PDM: 0.88, 95% CI: 0.22-3.50, P = 0.861) between groups.

Conclusions

Endoscopic and conventional discectomy reduced patient pain comparably, but endoscopic discectomy had significantly lower operation time and lower risk in complications, which may impact other outcomes such as recovery and healthcare costs. More studies are needed to confirm our findings.

Supplementary information

The online version contains supplementary material available at 10.1007/s43465-022-00636-1.

SUBMITTER: Lu H

PROVIDER: S-EPMC9123128 | biostudies-literature | 2022 Jun

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Percutaneous Endoscopic Lumbar Discectomy for Recurrent Lumbar Disc Herniation: An Updated Systematic Review and Meta-Analysis.

Lu Honghui H Yao Yu Y Shi Ligang L

Indian journal of orthopaedics 20220422 6

<h4>Objective</h4>This meta-analysis evaluated surgical outcomes following endoscopic or conventional discectomy for recurrent lumbar disc herniation.<h4>Methods</h4>Medline, Cochrane, EMBASE, and Google Scholar were search until October 16, 2016 using these terms: recurrent lumbar disc herniation, endoscopic surgery, and discectomy. Randomized controlled trials (RCTs), prospective, retrospective, and cohort studies were eligible for inclusion. Pooled difference in mean (PDM) with 95% confidence ...[more]

PMID: 35669028

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Project description:Background:Percutaneous endoscopic transforaminal discectomy (PETD) is regarded as a viable alternative option for upper lumbar disc herniation (LDH). However, few studies have evaluated PETD for upper LDH, and no study has compared the advantages of endoscopic procedures versus conventional surgery. The present study was aimed at comparing the surgical outcome and safety of PETD versus conventional open lumbar discectomy in the treatment of upper LDH. Methods:Data from 42 patients treated for upper LDH from July 2015 to July 2018 were retrospectively analyzed, including 21 patients treated with PETD (PETD group) and 21 patients treated with conventional posterior lumbar discectomy (open group). The two groups were compared regarding demographic information, physical examination, radiological evaluations, and perioperative indicators. The clinical outcomes were assessed in accordance with the Oswestry Disability Index (ODI), visual analog scale (VAS), and modified MacNab criteria. Results:The postoperative ODI and VAS scores were significantly improved in both groups compared with the preoperative baseline values (P < 0.001), and the satisfactory rate was 90.5% in both groups in accordance with the modified MacNab criteria. There were no significant differences between the two groups in the clinical outcomes and complication rate (P < 0.001), and the satisfactory rate was 90.5% in both groups in accordance with the modified MacNab criteria. There were no significant differences between the two groups in the clinical outcomes and complication rate (P < 0.001), and the satisfactory rate was 90.5% in both groups in accordance with the modified MacNab criteria. There were no significant differences between the two groups in the clinical outcomes and complication rate (. Conclusions:PETD has a similar outcome to the conventional surgical method for the treatment of upper LDH but provides the typical advantages of minimally invasive procedures such as reduced iatrogenic injury, minimal activity restrictions, and accelerated ambulation recovery postoperatively.

Project description:BackgroundTransforaminal percutaneous endoscopic lumbar discectomy (PELD) is a widely used basic technique for lumbar disc herniation (LDH) with advantages including causing less trauma and fast recovery. The secure, efficient, and rapid enlargement of the intervertebral foramen is a key step in PELD procedures. However, the conventional multi-step trephine system for foraminoplasty involves complicated surgical procedures. In this study, we reported an improved one-step foraminoplasty via a large trephine with simplified surgical procedures, reduced radiation exposure, and shortened operative time.Methods70 LDH patients who underwent PELD were retrospectively reviewed in this study. The conventional multi-step trephine system was used for foraminoplasty in 35 patients in the multi-step (MS) group, and the single large trephine was used in the other 35 patients in the one-step (OS) group. Indicators including the operative time, the time to establish the working cannula, intraoperative fluoroscopy times, the radiation dose, and postoperative complications were compared between the MS and OS group.ResultsThe operative time and the time to establish the working cannula in the OS group was significantly shorter than that in the MS group (P < 0.01); intraoperative fluoroscopy times and the radiation dose in the OS group were significantly smaller than those in the MS group (P < 0.01). There was no statistical difference in the incidence of postoperative complications between the two groups (P > 0.05). The postoperative VAS scores and ODI scores (2 days and 3 months after the surgery) were significantly lower than the preoperative scores in both groups (P < 0.01), and there was no statistical difference in VAS scores or ODI scores between the two groups at the same time points (P > 0.05).ConclusionsThe one-step foraminoplasty via a single large trephine is an optimized technique evolving from the conventional multi-step foraminoplasty, showing significant superiority in simplified operation, shorted operative time, and reduced radiation exposure.

Project description:Study designSecondary analysis of data from a concurrent randomized trial and cohort study.ObjectiveThe aim of this study was to determine risks and predictors of recurrent pain following standard open discectomy for subacute/chronic symptomatic lumbar disc herniation (SLDH).Summary of background dataMost previous studies of recurrence after discectomy do not explicitly define pain resolution and recurrence, and do not account for variable durations of time at risk for recurrence.MethodsWe used survival analysis methods to examine predictors of leg pain recurrence. For individuals with initial resolution of leg pain, we defined recurrent leg pain as having leg pain, receiving lumbar epidural steroid injections, or undergoing lumbar surgery subsequent to initial leg pain resolution. We calculated cumulative risks of leg pain recurrence using Kaplan-Meier survival curves, and examined predictors of recurrence using Cox proportional hazards models. We used similar methods to examine LBP recurrence.ResultsOne- and three-year cumulative risks of leg pain recurrence were 20% and 45%, respectively. One- and three- year leg pain recurrence risks were substantially lower in participants with complete initial resolution of leg pain (17% and 41%, respectively) than in those without (27% and 54%, respectively). In multivariate analyses, complete leg pain resolution (adjusted hazard ratio [aHR] 0.69; 95% confidence interval [CI] 0.52-0.90), smoking (aHR 1.68 [95% CI 1.22-2.33]), and depression (aHR 1.74 [95% CI 1.18-2.56]) predicted leg pain recurrence. The 1- and 3-year risk of LBP recurrence was 29% and 65%, respectively. LBP recurrence risk at 3 years was substantially lower in participants with complete initial resolution of LBP than in those without, but not at 1 year.ConclusionRecurrence of leg pain and LBP is common after discectomy for SLDH. Cumulative risks of both leg pain and LBP recurrence were generally lower in participants achieving complete initial resolution of pain post-discectomy.Level of evidence2.

Dataset Information

Percutaneous Endoscopic Lumbar Discectomy for Recurrent Lumbar Disc Herniation: An Updated Systematic Review and Meta-Analysis.

Objective

Methods

Results

Conclusions

Supplementary information

Publications

Percutaneous Endoscopic Lumbar Discectomy for Recurrent Lumbar Disc Herniation: An Updated Systematic Review and Meta-Analysis.

Similar Datasets

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