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Pain Physician Jan 2024Calcified lumbar disc herniation (CLDH) is a subtype characterized by calcification, leading to increased surgical complexity. Percutaneous endoscopic lumbar discectomy... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Calcified lumbar disc herniation (CLDH) is a subtype characterized by calcification, leading to increased surgical complexity. Percutaneous endoscopic lumbar discectomy (PELD) is a minimally invasive technique, but its effectiveness and complications in CLDH patients remain to be fully evaluated.
OBJECTIVE
To assess the effectiveness and complications of PELD in treating CLDH patients.
STUDY DESIGN
A retrospective cohort study combined with a systematic review and meta-analysis.
SETTING
Department of Pain Medicine, an affiliated hospital of a university.
METHODS
Data from patients who underwent PELD in our department between March 2020 and May 2021 were collected. Forty CLDH patients were included in the study group, and equally matched cases with uncalcified lumbar disc herniation (UCLDH) served as controls. A systematic search was conducted on October 5, 2022, using EMBASE, PubMed, Cochrane Library, the China Biology Medicine disk, the China National Knowledge Infrastructure, and the Wanfang databases, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A random-effects model was used to calculate pooled results.
RESULTS
Eighty patients were included in the retrospective cohort, and 41 studies were included in the meta-analysis. Both the retrospective cohort and meta-analysis consistently showed a significant decrease in visual analog scale (VAS) and Oswestry Disability Index (ODI) scores in the CLDH group after the operation. In the retrospective cohort, the excellent or good rate according to the MacNab classification was 85%, with no reported complications. The meta-analysis revealed a pooled excellent or good rate of 91.8% and a low complication rate of 2.9%. Combining the findings from our retrospective cohort and meta-analysis, we observed that the CLDH group had longer operation times and slightly higher postoperative ODI scores compared to the UCLDH group.
LIMITATIONS
Small sample size and lack of long-term follow-up in the retrospective cohort, as well as limited inclusion of comparative studies in the meta-analysis.
CONCLUSION
PELD is an effective and safe treatment option for CLDH patients. In comparison to UCLDH patients, CLDH patients may experience longer operation times and slightly slower functional recovery than those with UCLDH.
Topics: Humans; Diskectomy, Percutaneous; Intervertebral Disc Displacement; Lumbar Vertebrae; Retrospective Studies
PubMed: 38285024
DOI: No ID Found -
Applied Bionics and Biomechanics 2023[This retracts the article DOI: 10.1155/2022/5360277.].
Retracted: Short-Term Postoperative Pain and Function of Unilateral Biportal Endoscopic Discectomy versus Percutaneous Endoscopic Lumbar Discectomy for Single-Segment Lumbar Disc Herniation: A Systematic Review and Meta-analysis.
[This retracts the article DOI: 10.1155/2022/5360277.].
PubMed: 37946825
DOI: 10.1155/2023/9869037 -
Global Spine Journal Jul 2023Systematic review.
STUDY DESIGN
Systematic review.
OBJECTIVES
It remains unknown whether general anesthesia (GA) or local ± epidural anesthesia (LA) results in superior outcomes with percutaneous endoscopic lumbar discectomy (PELD). The present study sought to examine the impact of anesthesia type on patient-reported outcomes (PROs) and complications with PELD.
METHODS
Systematic review and meta-analysis examining PELD performed under GA or LA was conducted. Patient-reported outcomes including Visual Analog Scale (VAS)-leg/back, and Oswestry Disability Index (ODI) scores were collected. Complication, recurrent disc herniation, durotomy, and reoperation rates as well as surgical data were recorded. All outcomes were compared between pooled studies examining GA or LA.
RESULTS
Sixty-eight studies consisting of 5269 patients (724 GA, 4465 LA) were included in the meta-analysis. Overall complication rate was significantly higher in the GA group (9% vs 4%, = .003). Durotomy rates, length of stay, recurrent disc herniation and reoperation rates were similar between groups. At the first follow-up timepoint, the LA group demonstrated significant improvements in VAS back and ODI scores ( < .05) while the GA group did not ( > .05). At the final follow-up (> 6 months), the percent of patients achieving an excellent McNab score was significantly higher in the GA vs LA group ( < .001).
CONCLUSIONS
Percutaneous endoscopic lumbar discectomy with LA may be associated with greater short-term improvement in VAS back pain and ODI scores. General anesthesia may be associated with more durable pain relief but a higher complication rate. Further systematic investigation is necessary to determine what short and long term benefits are associated with PELD performed under LA and GA.
PubMed: 36564907
DOI: 10.1177/21925682221147868 -
Journal of Orthopaedic Surgery and... Dec 2022Since there are currently no systematic evidence-based medical data on the efficacy and safety of PECD, this meta-analysis pooled data from studies that reported the... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Since there are currently no systematic evidence-based medical data on the efficacy and safety of PECD, this meta-analysis pooled data from studies that reported the efficacy or safety of PECD for cervical disc herniation to examine the efficacy, recurrence and safety of using PECD to treat cervical disc herniation.
METHODS
We searched the PubMed, EMBASE and Cochrane Library databases for studies published from inception to July 2022. Nine nonrandomized controlled trials (non-RCTs) that reported the efficacy or safety of percutaneous endoscopic cervical discectomy for cervical disc herniation were included. We excluded duplicate publications, studies without full text, studies with incomplete information, studies that did not enable us to conduct data extraction, animal experiments and reviews. STATA 15.1 software was used to analyse the data.
RESULTS
The proportions of excellent and good treatment results after PECD for CDH were 39% (95% CI: 31-48%) and 47% (95% CI: 34-59%), respectively. The pooled results showed that the VAS scores at 1 week post-operatively (SMD = -2.55, 95% CI: - 3.25 to - 1.85) and at the last follow-up (SMD = - 4.30, 95% CI: - 5.61 to - 3.00) after PECD for cervical disc herniation were significantly lower than the pre-operative scores. The recurrence rate of neck pain and the incidence of adverse events after PECD for cervical disc herniation were 3% (95% CI: 1-6%) and 5% (95% CI: 2-9%), respectively. Additionally, pooled results show that the operative time (SMD = - 3.22, 95% CI: - 5.21 to - 1.43) and hospital stay (SMD = - 1.75, 95% CI: - 2.67to - 0.84) were all significantly lower for PECD than for ACDF. The pooled results also showed that the proportion of excellent treatment results was significantly higher for PECD than for ACDF (OR = 2.29, 95% CI: 1.06-4.96).
CONCLUSION
PECD has a high success rate in the treatment of CHD and can relieve neck pain, and the recurrence rate and the incidence of adverse events are low. In addition, compared with ACDF, PECD has a higher rate of excellent outcomes and a lower operative time and hospital stay. PECD may be a better option for treating CHD.
Topics: Animals; Humans; Intervertebral Disc Displacement; Neck Pain; Diskectomy, Percutaneous; Diskectomy; Endoscopy
PubMed: 36456964
DOI: 10.1186/s13018-022-03365-1 -
Frontiers in Surgery 2022In order to compare the outcomes of percutaneous transforaminal endoscopic discectomy (PTED) and open lumbar discectomy (OLD) for lumbar disc herniation (LDH). (Review)
Review
PURPOSE
In order to compare the outcomes of percutaneous transforaminal endoscopic discectomy (PTED) and open lumbar discectomy (OLD) for lumbar disc herniation (LDH).
METHODS
The Pubmed, Cochrane Library, Web of Sience, Embase, Clinicaltrials.gov, CBM, CNKI, VIP, Wangfang databases were searched from inception to April 30, 2022 to collect the published studies about PTED vs. OLD for treatment of LDH. The Revman 5.2 was used for data analysis. The primary outcomes were excellent rates, complication rates and reoperation rates. The secondary outcomes were length of incision, length of operation, length of hospital stay, and the amount of intraoperative blood loss.
RESULTS
A total of nine studies were included, of which, eight randomized controlled trials and one retrospective study involving 1,679 patients with LDH (755 patients for PTED, and 924 patients for OLD) were included. According to meta-analysis, there were no significant difference in excellent rates (odds ratio [OR] = 1.47, 95% confidence intervals [CI]: 0.94-2.28, = 0.09), reoperation rates (OR = 0.96, 95% CI: 0.50-1.84, = 0.90), length of operation [standardized mean differences (SMD) = -17.97, 95%CI: -54.83-18.89, = 0.34], and the amount of intraoperative blood loss (SMD = -128.05, 95%CI: -258.67-2.57, = 0.05), respectively. There were significant differences in complication rates (OR = 0.22, 95% CI: 0.14-0.33, < 0.001), length of incision (SMD = -2.76, 95%CI: -2.88--2.65, < 0.001), and length of hospital stay (SMD = -5.19, 95%CI: -5.36--5.01, < 0.001), respectively.
CONCLUSIONS
PTED can achieve better outcomes with respect to the complication rates, length of incision, and length of hospital stay compared with OLD.
PubMed: 36439526
DOI: 10.3389/fsurg.2022.984868 -
Journal of Clinical Medicine Nov 2022Due to recent developments and the wide application of percutaneous transforaminal discectomy (PTED), we herein compare it with microendoscopic discectomy (MED) and... (Review)
Review
OBJECTIVE
Due to recent developments and the wide application of percutaneous transforaminal discectomy (PTED), we herein compare it with microendoscopic discectomy (MED) and traditional open surgery (OD) through surgical indicators and postoperative outcomes to evaluate the advantages and disadvantages of minimally invasive surgery PTED.
METHODS
This systematic review and meta-analysis was conducted in line with PRISMA guidelines (PROSPERO2018: CRD42018094890). We searched four English and two Chinese databases from the date of their establishment to May 2022. Randomized controlled trials and case-control studies of PTED versus MED or PTED versus OD in the treatment of lumbar disc herniation were retrieved.
RESULTS
A total of 33 studies with 6467 cases were included. When comparing MED with PTED, the latter had less intraoperative blood loss, smaller incision, shorter postoperative bed times, shorter hospitalization times, better postoperative visual analogue scale (VAS) for low back pain, and postoperative dysfunction index (Oswestry Disability Index, ODI) and higher recurrence rates and revision rates. However, operation times, postoperative VAS leg scores and complications, and successful operation rates were similar in both groups. Comparison of PTED with OD revealed in the former less intraoperative blood loss and smaller incision, shorter postoperative bed times, shorter hospitalization times, shorter operation times, and higher recurrence rates and revision rates. Nonetheless, comprehensive postoperative VAS scores, VAS leg pain scores, VAS low back pain, ODI and incidence of complications, and successful operation rates were similar between the two groups.
CONCLUSIONS
The therapeutic effect and safety of PTED, MED and OD in the treatment of lumbar disc herniation were comparable. PTED had obvious advantages in that it is minimally invasive, with rapid recovery after surgery, but its recurrence rates and revision rates were higher than MED and OD. Therefore, it is not possible to blindly consider replacing MED and OD with PTED.
PubMed: 36431083
DOI: 10.3390/jcm11226604 -
Journal of Spine Surgery (Hong Kong) Sep 2022Open discectomy (OD) and microdiscectomy (MD) are routine procedures for the treatment of lumbar disc herniation. Minimally invasive surgery (MIS), such as... (Review)
Review
BACKGROUND
Open discectomy (OD) and microdiscectomy (MD) are routine procedures for the treatment of lumbar disc herniation. Minimally invasive surgery (MIS), such as micro-endoscopic discectomy (MED) and full endoscopic discectomy (FED), offers potential advantages (less pain, less bleeding, shorter hospitalisation and earlier return to work), but their complications have not yet been fully evaluated. The aim of this paper was to identify the frequency of these complications with a focus on MIS in comparison to OD/MD.
METHODS
The authors conducted a Medline database search for randomised controlled and prospective cohort studies reporting complications associated with MIS and MD/OD from 1997 to February 2020. Included studies were assessed for bias using the Newcastle-Ottawa Quality assessment form. Mean complication rates for each technique were calculated by dividing the total number of each complication by the total number of patients included in the studies which reported that specific complication.
RESULTS
Of the 1,095 articles retrieved from Medline, 35 met the inclusion criteria. OD, MD, MED and FED were associated with: recurrent lumbar disc hernias in 4.1%, 5.1%, 3.9% and 3.5% respectively; re-operations in 5.2%, 7.5%, 4.9% and 4% respectively; wound complications in 3.5%, 3.5%, 1.2% and 2% respectively; durotomy in 6.6%, 2.3%, 4.4% and 1.1% respectively; neurological complications in 1.8%, 2.8%, 4.5% and 4.9% respectively. Nerve root injury was reported in 0.3% for MD, 0.8% for MED and 1.2% for FED.
DISCUSSION
This up-to-date systematic review of complications after various techniques of lumbar discectomy (including a large pool of patients who had MIS) confirms previous findings of low and comparable rates. However variable levels of bias were reported amongst included studies, which reported complications with varying levels of clinical detail.
PubMed: 36285095
DOI: 10.21037/jss-21-59 -
Medicine Sep 2022The purpose of this study was to analyze unilateral biportal endoscopic discectomy (UBE) and percutaneous endoscopic lumbar discectomy (PELD) for the treatment of lumbar... (Meta-Analysis)
Meta-Analysis
Comparison of unilateral biportal endoscopic discectomy versus percutaneous endoscopic lumbar discectomy for the treatment of lumbar disc herniation: A systematic review and meta-analysis.
BACKGROUND
The purpose of this study was to analyze unilateral biportal endoscopic discectomy (UBE) and percutaneous endoscopic lumbar discectomy (PELD) for the treatment of lumbar disc herniation.
METHODS
PubMed, EMBASE, Web of Science, Cochrane Database, CNKI, and Wanfang databases were searched online. All statistical analyses were performed using STATA 16.0.
RESULTS
The selection criteria were met by 6 studies with a total of 281 patients (142 cases in the UBE group and 139 cases in the PELD group) and good methodological quality. PELD has the potential to improve outcomes such as operation time and intraoperative hemorrhage (MD = 36.808, 95% CI (23.766, 49.850), P = .000; MD = 59.269, 95% CI (21.527, 97.010), P = .000) compared with UBE. No differences were found in the back pain VAS score at preoperative (MD = -0.024, 95% CI [-0.572, 0.092], P = .998), at 1 day after operation (MD = -0.300, 95% CI [-0.845, 0.246], P = .878), the VAS score of leg pain at preoperative (MD = -0.099, 95% CI [-0.417, 0.220], P = .762), at 1 day after operation (MD = 0.843, 95% CI [0.193, 1.492], P = .420), at 1 month after operation (MD = -0.027, 95% CI [-0.433, 0.380], P = .386), at 6 months after operation (MD = 0.122, 95% CI [-0.035, 0.278], P = .946), hospital stay (MD = 3.708, 95% CI [3.202, 4.214], P = .000) and other clinical effects between UBE and PELD group.
CONCLUSIONS
There are no significant differences in clinical efficacy between UBE and PELD, according to the research. However, PELD has the potential to improve outcomes such as operation time and intraoperative hemorrhage. As just a result, PELD is better suited in the treatment of lumbar disc herniation.
Topics: Diskectomy; Diskectomy, Percutaneous; Endoscopy; Hemorrhage; Humans; Intervertebral Disc Displacement; Lumbar Vertebrae; Retrospective Studies; Treatment Outcome
PubMed: 36181014
DOI: 10.1097/MD.0000000000030612 -
Frontiers in Surgery 2022This study aimed to evaluate the efficacy and safety of unilateral biportal endoscopy (UBE) versus other forms of spine surgery. (Review)
Review
BACKGROUND
This study aimed to evaluate the efficacy and safety of unilateral biportal endoscopy (UBE) versus other forms of spine surgery.
METHODS
Electronic databases were systematically searched up to February 2022. The authors used Review Manager 5.3 to manage the data and perform the review.
RESULTS
After the preliminary selection of 239 studies from electronic databases, the full inclusion criteria were applied; 16 studies were found to be eligible for inclusion. These 16 studies enrolled 1,488 patients: 653 patients in the UBE group, 570 in the microendoscopic discectomy group, 153 in the percutaneous endoscopic lumbar discectomy group, and 70 in the posterior lumbar interbody fusion group. UBE was superior to microendoscopic discectomy regarding 1-day Visual Analog Scale(VAS) back pain scores ( < 0.00001). No difference was found between UBE and microendoscopic discectomy regarding 1-day Visual Analog Scale leg pain scores ( = 0.25), long-term VAS back pain scores ( = 0.06), long-term VAS leg pain scores ( = 0.05), Oswestry Disability Index scores ( = 0.09) or complications ( = 0.19). Pooled analysis indicated that UBE was similar to percutaneous endoscopic lumbar discectomy regarding 1-day VAS back pain scores ( = 0.71), 1-day VAS leg pain scores ( = 0.37), long-term VAS back pain scores ( = 0.75), long-term VAS leg pain scores ( = 0.41), Oswestry Disability Index scores ( = 0.07) and complications ( = 0.88). One study reported no difference between UBE and posterior lumbar interbody fusion regarding long-term VAS back pain, long-term VAS leg pain, or Oswestry Disability Index scores.
CONCLUSIONS
UBE is superior to microendoscopic discectomy to relieve back pain 1 day postoperatively. However, these two procedures are similar regarding 1-day leg pain relief, long-term effects, and safety. UBE and percutaneous endoscopic lumbar discectomy are similar regarding 1-day pain relief, long-term effects and safety. More evidence is needed to evaluate the efficacy and safety of UBE versus posterior lumbar interbody fusion.
PubMed: 35959116
DOI: 10.3389/fsurg.2022.911914 -
Annals of Palliative Medicine Aug 2022For some patients, local anesthesia (LA) in percutaneous transforaminal endoscopic discectomy (PTED), especially during canal shaping and discectomy, is insufficient for... (Meta-Analysis)
Meta-Analysis
BACKGROUND
For some patients, local anesthesia (LA) in percutaneous transforaminal endoscopic discectomy (PTED), especially during canal shaping and discectomy, is insufficient for analgesia. Epidural anesthesia (EA) is infrequently applied in PTED but reports satisfactory results. Previous studies present conflicting results in analgesia satisfactory and adverse events. Differences in surgery details and small sample size might explain conflicting results. Meta-analysis pools the results from individual studies to create a larger sample size and provides a more reliable conclusion. The aim of this study is to evaluate the efficacy and safety of EA in PTED.
METHODS
The search terms "percutaneous transforaminal endoscopic discectomy" and "anesthesia" are used to search Cochrane, Web of Science, PubMed, Embase, OVID, China National Knowledge Infrastructure (CNKI), VIP, and Wanfang from inception to 2021-08. Inclusion criteria is defined according to PICOS principals: P (patients): patients are diagnosed with lumbar disc herniation or spinal canal stenosis. I (intervention): patients undergo PTED under EA. C (comparisons): patients undergo PTED under LA. O (outcomes): primary outcomes: intraoperative visual analogue scale (VAS), anesthesia satisfactory, sufentanil usage. Secondary outcomes: adverse events, surgery exit, bleed volume, X-ray radiation. S (study design): randomized controlled trials (RCTs). The Cochrane RoB 2.0 is used to evaluate the quality of the included studies. Authors perform meta-analysis through Review Manager 5.4.
RESULTS
A total of 6 studies representing 529 patients are included: EA group includes 261 patients, and LA group includes 268 patients. All studies lack design of allocation concealment and blinding of participants and personnel. Only Luo reports blinding of outcome assessment in 2019. Meta analysis concludes that EA is superior in intraoperative analgesic [mean difference (MD) =-4.31; 95% confidence interval (CI): -4.52 to -4.09; P<0.00001], anesthesia satisfactory [odds ratio (OR) =10.06; 95% CI: 2.41 to 41.98; P=0.002], sufentanil usage (MD =-9.12; 95% CI: -10.34 to -7.90; P<0.00001), adverse events (OR =0.19; 95% CI: 0.07 to 0.52; P=0.001). There is no difference in bleed volume (MD =-2.61; 95% CI: -5.45 to 0.23; P=0.07), exit rate (OR =0.23; 95% CI: 0.04 to 1.35; P=0.10) and future effects (MD =-0.23; 95% CI: -0.50 to 0.03; P=0.08).
DISCUSSION
EA is an effective and safe anesthesia method for PTED and might achieve better clinical results than LA. More high-quality research is needed to provide high-quality evidence for efficacy and safety.
Topics: Anesthesia, Epidural; Anesthesia, Local; Diskectomy; Humans; Lumbar Vertebrae; Sufentanil; Treatment Outcome
PubMed: 35871273
DOI: 10.21037/apm-21-3413