Microendoscopic lumbar discectomy with general versus local anesthesia: A systematic review and meta-analysis

James Mooney; Nicholas Erickson; Arsalaan Salehani; Nick Laskay; Anil Mahavadi; Adeel Ilyas; Bipul Mainali; Nitin Agarwal; Jakub Godzik

doi:10.1016/j.xnsj.2022.100129

Microendoscopic lumbar discectomy with general versus local anesthesia: A systematic review and meta-analysis

N Am Spine Soc J. 2022 May 30:10:100129. doi: 10.1016/j.xnsj.2022.100129. eCollection 2022 Jun.

Authors

James Mooney¹, Nicholas Erickson¹, Arsalaan Salehani¹, Nick Laskay¹, Anil Mahavadi¹, Adeel Ilyas¹, Bipul Mainali², Nitin Agarwal³, Jakub Godzik¹

Affiliations

¹ Department of Neurosurgery, University of Alabama at Birmingham, AL, USA.
² School of Medicine, University of Alabama at Birmingham, AL, USA.
³ Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO, USA.

Abstract

Background: While general anesthesia (GA) is the most commonly used anesthetic method during lumbar microendoscopic discectomy (MED), local ± epidural anesthesia (LA) has been gaining popularity as an alternate method. Theoretical advantages of LA include reduced morbidity of anesthesia and improved surgeon-patient communication facilitating less nerve root manipulation and yielding improved surgical outcomes. The objective of this systematic review is to examine the impact of anesthesia type on patient reported outcomes (PROs) and complications with MED.

Methods: A systematic review and meta-analysis of the available literature examining MED performed under GA or LA was performed. The PubMed, EMBASE and SCOPUS databases were searched from inception to August 16, 2021, utilizing strict inclusion and exclusion criteria with all studies reporting greater than 6 months of follow-up and PRO data. PROs including Visual Analog Scale (VAS)-leg/back, Oswestry Disability Index (ODI), Japanese Orthopedic Association (JOA) and/or 36-Item Short Form (SF-36) physical component scores were collected. Complication, recurrent disc herniation, durotomy and reoperation rates as well as surgical factors were collected. All outcomes were compared between pooled studies examining GA or LA. Risk of bias was assessed with the Newcastle-Ottawa Scale.

Results: A total of 23 studies consisting of 2,868 patients (1,335 GA, 1,533 LA) were included in the meta-analysis. There were no significant differences between GA and LA groups in regard to overall complication rate, durotomy rate, recurrent disc herniation rate, reoperation rate, blood loss, or surgical time (p > 0.05). Both groups demonstrated significant improvements in ODI and JOA (p<0.0004), however leg and back VAS was only improved in GA (p<0.0025) and not in LA (p>0.058), and SF-36 only in LA (p=0.003).

Conclusions: Patients undergoing MED under both anesthetic techniques demonstrated significant improvements in ODI and JOA, with no significant differences in complication or reoperation rates. However, patients undergoing GA demonstrated significant improvement in VAS leg and back pain at last follow-up while LA did not. LA may be offered to carefully selected patients and prior studies have demonstrated reduced costs and risks with LA. Conclusions are limited by a high level of study bias and heterogeneity. Further investigation is needed to assess the true effects of GA and LA on outcomes after MED.

Keywords: General anesthesia; Local/epidural anesthesia; Meta-analysis; Microendoscopic discectomy; Patient-reported outcomes; Spine; Surgical outcomes; Systematic review.

Publication types

Review