Percutaneous Endoscopic Lumbar Discectomy for L5S1 Lumbar Disc Herniation Using a Transforaminal Approach Versus an Interlaminar Approach: A Systematic Review and Meta-Analysis

Jiageng Chen; Xiyue Jing; Changping Li; Yu Jiang; Sijin Cheng; Jun Ma

doi:10.1016/j.wneu.2018.05.075

Percutaneous Endoscopic Lumbar Discectomy for L5S1 Lumbar Disc Herniation Using a Transforaminal Approach Versus an Interlaminar Approach: A Systematic Review and Meta-Analysis

World Neurosurg. 2018 Aug:116:412-420.e2. doi: 10.1016/j.wneu.2018.05.075. Epub 2018 May 18.

Authors

Jiageng Chen¹, Xiyue Jing¹, Changping Li¹, Yu Jiang², Sijin Cheng³, Jun Ma⁴

Affiliations

¹ Department of Health Statistics, School of Public Health, Tianjin Medical University, Tianjin, China.
² Department of Orthopedics, Nanjing Medical University Affiliated Wuxi Second Hospital, Wuxi, China.
³ Tongji University School of Medicine, Shanghai, China.
⁴ Department of Health Statistics, School of Public Health, Tianjin Medical University, Tianjin, China. Electronic address: tjykdmajun@163.com.

PMID: 29783008
DOI: 10.1016/j.wneu.2018.05.075

Abstract

Background: Several studies have compared the clinical efficacy of percutaneous endoscopic lumbar discectomy for L5-S1 lumbar disc herniation (LDH) using a transforaminal approach with an interlaminar approach, but with contradictory results. The aim of this study was to explore the comparison of efficacy and safety between percutaneous endoscopic transforaminal discectomy (PETD) and percutaneous endoscopic interlaminar discectomy (PEID) for L5-S1 LDH.

Methods: Six common databases were comprehensively searched, and relevant studies were included into the analysis when they met all the inclusion criteria.

Results: Nine studies involving 621 patients were included into the study. The results indicated that PETD was significantly associated with greater fluoroscopy times (mean difference [MD], 9.28 times; 95% confidence interval [CI], 6.84-11.71; P < 0.01) and longer operative time (MD, 16.51 minutes; 95% CI, 4.01-29.02; P = 0.01) compared with PEID. However, there were no distinct differences between PETD and PEID in estimated blood loss (P = 0.24), bed time after surgery (P = 0.32), hospitalization time (P = 0.27), or MacNab evaluation (P = 0.78). Similarly, no obvious differences were detected between PETD and PEID regarding Visual Analogue Scale score, Japanese Orthopedic Association (JOA) score, or Oswestry Disability Index (ODI) when measured preoperatively, 1 day postoperatively, 3 months postoperatively, or at the last follow up. In addition, no significant difference was found regarding overall incidence of complications between PETD and PEID (P = 0.14). Nevertheless, a significantly lower incidence rate of dural tear was observed in PETD compared with PEID (P = 0.04).

Conclusions: PETD had comparable clinical efficacy and safety compared with PEID; however, PEID was superior to PETD regarding fluoroscopy times and operative time. Therefore, PEID might be a better surgical procedure for L5S1 LDH.

Keywords: Interlaminar; Lumbar disc herniation; Meta-analysis; Percutaneous endoscopic lumbar discectomy; Transforaminal.

Publication types

Meta-Analysis
Review
Systematic Review

MeSH terms

Diskectomy, Percutaneous* / methods
Humans
Intervertebral Disc Degeneration / surgery*
Intervertebral Disc Displacement / surgery*
Lumbosacral Region / surgery*
Time Factors
Treatment Outcome

Supplementary concepts

Intervertebral disc disease