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Indian Journal of Orthopaedics Jun 2022This meta-analysis evaluated surgical outcomes following endoscopic or conventional discectomy for recurrent lumbar disc herniation.
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, < 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, = 0.003). No significant difference in the improvement in VAS (PDM: -2.19, 95% CI: -5.78 to 1.39, = 0.231), length of stay (PDM: -6.44, 95% CI: -13.76 to 0.89, = 0.085) and re-recurrence rate (PDM: 0.88, 95% CI: 0.22-3.50, = 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.
PubMed: 35669028
DOI: 10.1007/s43465-022-00636-1 -
Applied Bionics and Biomechanics 2022Spinal surgery is gradually moving toward minimally invasive surgery, but there is still some lack of knowledge about the Unilateral Biportal Endoscopic (UBE) technique...
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.
OBJECTIVE
Spinal surgery is gradually moving toward minimally invasive surgery, but there is still some lack of knowledge about the Unilateral Biportal Endoscopic (UBE) technique that has been hotly debated in recent years. We performed this systematic review and meta-analysis to clarify whether UBE is superior to percutaneous endoscopic lumbar discectomy (PELD) for relieving short-term postoperative pain and promoting functional recovery.
METHODS
Computer searches of PubMed, Embase, Cochrane Library, Web of Science, CNKI, and Wanfang databases were performed to search for studies on UBE versus PELD for single-segment lumbar disc herniation (ssLDH) from the time of database construction to Mar. 2022, and two investigators independently performed literature screening and data extraction, and evaluation of the quality of the included studies was observed as operation time, complications, and visual analogue scale (VAS) at each preoperative and postoperative stage as well as Oswestry Disability Index (ODI), and meta-analysis was performed by applying the Review Manager 5.4 software.
RESULTS
Meta-analysis showed that PELD had shorter operation time (MD = 35.36, 95% CI (4.67, 66.04), = 0.02) and had lower VAS of back pain at 3 days postoperatively (MD = 0.62, 95% CI (0.04, 1.19), = 0.04) compared to the UBE. However, there was no statistical significance between the two groups in terms of complications (MD = 2.53, 95% CI (0.40, 16.11), = 0.33), VAS of back pain at 30 days postoperatively (MD = 0.05, 95% CI (-0.19, 0.28), = 0.70), VAS of leg pain at 3 days postoperatively (MD = 0.21, 95% CI (-0.20, 0.61), = 0.33), VAS of leg pain at 30 days postoperatively (MD = 0.09, 95% CI (-0.29, 0.46), = 0.65), and ODI at 30 days postoperatively (MD = -0.81, 95% CI (-3.03, 1.41), = 0.47).
CONCLUSIONS
Current evidence suggests that both UBE and PELD are effective in relieving short-term postoperative pain and promoting functional recovery, and there is no difference in complications between them; UBE requires longer operation time, and PELD may be superior in relieving immediate postoperative pain. This trial is registered with PROSPERO ID: CRD42021287810.
PubMed: 35465181
DOI: 10.1155/2022/5360277 -
Clinical Spine Surgery Mar 2023A systematic review and meta-analysis. (Meta-Analysis)
Meta-Analysis
Microscopic Anterior Cervical Discectomy and Fusion Versus Posterior Percutaneous Endoscopic Cervical Keyhole Foraminotomy for Single-level Unilateral Cervical Radiculopathy: A Systematic Review and Meta-analysis.
STUDY DESIGN
A systematic review and meta-analysis.
OBJECTIVE
The objective of this study was to compare the safety of microscopic anterior cervical discectomy and fusion (MI-ACDF) and posterior percutaneous endoscopic keyhole foraminotomy (PPEKF) in patients diagnosed with single-level unilateral cervical radiculopathy.
SUMMARY OF BACKGROUND DATA
After conservative treatment, the symptoms will be relieved in about 90% of cervical radiculopathy patients. For the other one tenth of patients, surgical treatment is needed. The overall complication rate of MI-ACDF and PPEKF ranges from 0% to 25%, and the reoperation rate ranges from 0% to 20%.
MATERIALS AND METHODS
Electronic retrieval of studies from PubMed, Embase, and Cochrane Library was performed to identify comparative or single-arm studies on MI-ACDF and PPEKF. A total of 24 studies were included in our meta-analysis by screening according to the inclusion and exclusion criteria. After data extraction and quality assessment of the included studies, a meta-analysis was performed by using the R software. The pooled incidences of efficient rate, total complication rate, and reoperation rate were calculated.
RESULTS
A total of 24 studies with 1345 patients (MI-ACDF: 644, PPEKF: 701) were identified. There was no significantly statistical difference in pooled patient effective rate (MI-ACDF: 94.3% vs. PPEKF: 93.3%, P =0.625), total complication rate (MI-ACDF: 7.1% vs. PPEKF: 4.7%, P =0.198), and reoperation rate (MI-ACDF: 1.8% vs. PPEKF: 1.1%, P =0.312). However, the common complications of the 2 procedures were different. The most common complications of MI-ACDF were dysphagia and vertebral body sinking, whereas the most common complication of PPEKF was nerve root palsy.
CONCLUSIONS
Both MI-ACDF and PPEKF can provide a relatively safe and reliable treatment for single-level unilateral cervical radiculopathy. The 2 techniques are not significantly different in terms of effective rate, total complication rate, and reoperation rate.
Topics: Humans; Foraminotomy; Radiculopathy; Cervical Vertebrae; Treatment Outcome; Diskectomy; Spinal Fusion
PubMed: 35344521
DOI: 10.1097/BSD.0000000000001327 -
Journal of Healthcare Engineering 2022Systematic analysis of the incidence of percutaneous spinal endoscopic technique and traditional open surgery for lumbar disc herniation. (Meta-Analysis)
Meta-Analysis
OBJECTIVE
Systematic analysis of the incidence of percutaneous spinal endoscopic technique and traditional open surgery for lumbar disc herniation.
METHODS
A randomized controlled trial (RCT) and cohort study on complications related to traditional open surgery was searched on the MEDLINE, Cochrane Library, PubMed, Web of Science, Chinese journal full-text database (CNKI), Wanfang, and Embase database. Language is not limited. The quality of each study was evaluated, various complications were compiled into electronic baseline tables, and the data from these studies were available. Meta-analysis and synthesis were performed with the RevMan 5.3 software to evaluate the statistical significance of both surgical techniques in terms of various complications.
RESULTS
12 studies were eventually included, and a total of 2,797 patients were included in the analysis. Meta-analysis results showed that there was no statistical difference in postoperative paresthesia between percutaneous spinal endoscopy and traditional open surgery (OR = 1.17, 95% CI (0.82, 1.66), = 0.38, = 0%, = 0.88), direct nerve root damage (OR = 0.79, 95% CI (0.58, 1.07), = 0.13, = 73%, = 1.52), and intraoperative hemorrhage and hematoma formation (OR = 1.00, 95% CI (0.67, 1.48), = 0.99, = 0%, = 0.02), but there was a statistical difference in disc recurrence (OR = 2.24, 95% CI (1.56, 3.21), < 0.0001, = 81%, = 4.39).
CONCLUSION
Compared with the traditional open surgical treatment of lumbar disc herniation, percutaneous spinal endoscopic technology has obvious advantages in reducing nerve root injury, dural injury, and surgical area wound complications, but it is limited to preventing the technical characteristics of the surgical site, which is worse than that of open surgery.
Topics: Diskectomy, Percutaneous; Endoscopy; Humans; Intervertebral Disc Displacement; Lumbar Vertebrae; Randomized Controlled Trials as Topic; Treatment Outcome
PubMed: 35340255
DOI: 10.1155/2022/6033989 -
The Korean Journal of Pain Jan 2022Percutaneous transforaminal endoscopic discectomy (PTED) has been widely used in the treatment of lumbar degenerative diseases. Epidural injection of steroids can reduce...
BACKGROUND
Percutaneous transforaminal endoscopic discectomy (PTED) has been widely used in the treatment of lumbar degenerative diseases. Epidural injection of steroids can reduce the incidence and duration of postoperative pain in a short period of time. Although steroids are widely believed to reduce the effect of surgical trauma, the observation indicators are not uniform, especially the long-term effects, so the problem remains controversial. Therefore, the purpose of this paper was to evaluate the efficacy of epidural steroids following PTED.
METHODS
We searched PubMed, Embase, and the Cochrane Database from 1980 to June 2021 to identify randomized and non-randomized controlled trials comparing epidural steroids and saline alone following PTED. The primary outcomes included postoperative pain at least 6 months as assessed using a visual analogue scale (VAS) and the Oswestry Disability Index (ODI). The secondary outcomes included length of hospital stay and the time of return to work.
RESULTS
A total of 451 patients were included in three randomized and two nonrandomized controlled trials. The primary outcomes, including VAS and ODI scores, did not differ significantly between epidural steroids following PTED and saline alone. There were no significant intergroup differences in length of hospital stay. Epidural steroids were shown to be superior in terms of the time to return to work (P < 0.001).
CONCLUSIONS
Intraoperative epidural steroids did not provide significant benefits, leg pain control, improvement in ODI scores, and length of stay in the hospital, but it can enable the patient to return to work faster.
PubMed: 34966016
DOI: 10.3344/kjp.2022.35.1.97 -
Global Spine Journal Sep 2022Systematic review and meta-analysis.
STUDY DESIGN
Systematic review and meta-analysis.
OBJECTIVES
Cervical spine endoscopic discectomy and decompression have gained popularity in the last decade. This review aimed to shed light on the current outcomes of cervical spine endoscopic procedures for degenerative disc disease (DDD) and to calculate a pooled estimate of various outcome measures.
METHODS
We retrieved articles published in English related to endoscopic cervical spine procedures from 3 central databases from inception until September 2020. A subgroup analysis based on the anterior versus the posterior approach was performed.
RESULTS
Thirty-one articles fulfilled the eligibility criteria and included 1,410 patients. A successful outcome was observed in 91.3% (88.6-93.4%, = 0.000). This percentage was lower for the anterior approach (89.6% [85.8-92.5%], = 0.000) than for the posterior approach (94.2% [90.4-96.5%], = 0.000). A higher percentage of poor outcomes was reported for the anterior approach (5.7% [3.2-10.1%], = 0.000 vs. 2.3% [1-5.5%], = 0.000 for the posterior approach). The overall complication rate was 7.2% (5.2-9.8%, = 0.000). There was a slightly higher complication rate for the anterior approach (7.9% [4.5-13.3%], = 0.000) than for the posterior approach (6.7% [4.4-10%], = 0.000). The revision rate was 4.2% (2.6-6.8%, = 0.000); and 4.2% (1.8-9.7%, = 0.000) for the anterior approach and 4.00% (2.2-7.4%, = 0.000) for the posterior approach.
CONCLUSIONS
There is a higher success rate and lower complication rate with the posterior approach than with the anterior approach. However, high-quality randomized controlled trials are vital to evaluate the efficacy of these procedures.
PubMed: 34402323
DOI: 10.1177/21925682211037270 -
Global Spine Journal Jun 2022Systematic review.
STUDY DESIGN
Systematic review.
OBJECTIVE
The authors aimed to systematically compare the effectiveness and safety of endoscopic discectomy (ED) with non-endoscopic discectomy (NED) for treatment of symptomatic lumbar disc herniation (LDH).
METHODS
A systematic search was performed on PubMed, EMBASE, the Cochrane Library and China National Knowledge Infrastructure for randomized controlled trial from inception until August 13, 2020. Trials which investigated multiple operative approaches on lumbar disc herniation were identified without language restrictions.
RESULTS
In total, 25 trials involving 2258 patients with symptomatic LDH were included. Twenty trials performed the comparison between ED and NED. Five trials performed the comparison between percutaneous endoscopic transforaminal discectomy (PETD) and percutaneous endoscopic interlaminar discectomy (PEID). The operative time of micro-endoscopic discectomy (MED) was longer than open discectomy (OD). The length of hospital stay of percutaneous endoscopic lumbar discectomy (PELD) was shorter than fenestration discectomy (FD). Significant differences in intraoperative blood loss volumes were found between PELD with FD and MED with OD. The complication rate of PELD was lower than FD (PELD: 4.3%; FD: 14.6%) and the complication rate of full-endoscopic discectomy (FE) was lower than microscopic discectomy (MD) (FE: 13.4%; MD: 32.1%).
CONCLUSIONS
PELD and FE have the advantage of limiting intraoperative damages. ED and NED can be both considered sufficient to achieve good clinical outcomes. PETD and PEID are able to achieve similar results but the learning curve of PETD was steeper. More independent high-quality RCTs with sufficiently large sample sizes performing cost-effectiveness analyzes are needed.
PubMed: 34402320
DOI: 10.1177/21925682211020696 -
Frontiers in Surgery 2021Therapeutic options for lumbar disc surgery (LDH) have been rapidly evolved worldwide. Conventional pair meta-analysis has shown inconsistent results of the safety of...
Therapeutic options for lumbar disc surgery (LDH) have been rapidly evolved worldwide. Conventional pair meta-analysis has shown inconsistent results of the safety of different surgical interventions for LDH. A network pooling evaluation of randomized controlled trials (RCT) was conducted to compare eight surgical interventions on complications for patients with LDH. PubMed, Embase, and the Cochrane Central Register of Controlled Trials (CENTRAL) were searched for RCT from inception to June 2020, with registration in PROSPERO (CRD42020176821). This study is conducted in accordance with Cochrane guidelines. Primary outcomes include intraoperative, post-operative, and overall complications, reoperation, operation time, and blood loss. A total of 27 RCT with 2,948 participants and eight interventions, including automated percutaneous lumbar discectomy (APLD), chemonucleolysis (CN), microdiscectomy (MD), micro-endoscopic discectomy (MED), open discectomy (OD), percutaneous endoscopic lumbar discectomy (PELD), percutaneous laser disc decompression (PLDD), and tubular discectomy (TD) were enrolled. The pooling results suggested that PELD and PLDD are with lower intraoperative and post-operative complication rates, respectively. TD, PELD, PLDD, and MED were the safest procedures for LDH according to complications, reoperation, operation time, and blood loss. The results of this study provided evidence that PELD and PLDD were with lower intraoperative and post-operative complication rates, respectively. TD, PELD, PLDD, and MED were the safest procedures for LDH according to complications, reoperation, operation time, and blood loss. PROSPERO, identifier CRD42020176821.
PubMed: 34355013
DOI: 10.3389/fsurg.2021.679142 -
Pain Physician Jul 2021New approaches and technologies can be beneficial for patients but also bring corresponding complications. Traditional pairwise meta-analyses cannot be used to... (Meta-Analysis)
Meta-Analysis
BACKGROUND
New approaches and technologies can be beneficial for patients but also bring corresponding complications. Traditional pairwise meta-analyses cannot be used to comprehensively rank all surgical approaches.
OBJECTIVES
The purpose of this systematic review and network meta-analysis (NMA) was to compare the outcomes of different surgical approaches for lumbar disc herniation (LDH).
STUDY DESIGN
NMA of randomized controlled trials (RCTs) for multiple treatment comparisons of LDH.
METHODS
The PubMed, Embase, MEDLINE, Ovid, and Cochrane Library databases were searched for RCTs comparing different surgical approaches for patients with LDH from inception to February 10, 2020. The Markov chain Monte Carlo methods were used to perform a hierarchical Bayesian NMA in WinBUGS version 1.4.3 using a random effects consistency model. The primary outcomes were disability and pain intensity. The secondary outcomes were complications and reoperation. The PROSPERO number was CRD42020179406.
RESULTS
A total of 22 trials including 2529 patients and all 5 different approaches (open discectomy or microdiscectomy [OD/MD], microendoscopic discectomy [MED], percutaneous endoscopic discectomy [PED], percutaneous discectomy [PD], and tubular discectomy [TD]) were retrospectively retrieved. PED had the best efficacy in improving patients' dysfunction with no statistical significance (probability = 50%). PD was significantly worse than OD/MD, MED, and PED in relieving patients' pain (standardized mean differences: 0.87 [0.03, 1.76], 0.94 [0.06, 1.88], and 1.02 [0.13, 1.94], respectively). There was no statistically significant difference between any 2 surgical approaches in dural tear; intraoperative, postoperative, and overall complications; or reoperation rate. PED had the lowest dural tear rate and the lowest intraoperative and overall complication rates (probability = 51%, 67%, and 33%, respectively). TD had the lowest postoperative complication and reoperation rates (probability = 35% and 39%, respectively).
LIMITATIONS
The limitations of this NMA include the inconsistent follow-up times, the criteria for complications, and the reasons for reoperation.
CONCLUSIONS
Compared with other approaches used to treat LDH, PED had the best safety and efficacy in general, and TD had the lowest reoperation rate. Finally, we recommended PED for LDH.
Topics: Diskectomy, Percutaneous; Humans; Intervertebral Disc Degeneration; Intervertebral Disc Displacement; Lumbar Vertebrae; Network Meta-Analysis
PubMed: 34213864
DOI: No ID Found -
Orthopaedics & Traumatology, Surgery &... Nov 2021Intraoperative imaging in minimally invasive spinal surgeries is associated with significant radiation exposure to surgeons, which overtime can lead to serious health... (Review)
Review
BACKGROUND
Intraoperative imaging in minimally invasive spinal surgeries is associated with significant radiation exposure to surgeons, which overtime can lead to serious health hazards including malignancy. In this study, the authors conducted a systematic review to evaluate the efficacy of navigation assisted fluoroscopy methods on radiation exposure to the surgeon in minimally invasive spine surgeries, percutaneous endoscopic lumbar discectomy/percutaneous endoscopic transforaminal discectomy versus minimally invasive spine transforaminal lumbar interbody fusion (PELD/PETD versus MIS-TLIF).
METHODS
A systematic literature search was conducted using PUBMED/MEDLINE on 20th July, 2020. Inclusion criteria were applied according to study design, surgical technique, spinal region, and language. Data extracted included lumbar segment, average operation time (min), fluoroscopic time (s), and radiation dose (μSV), efficacy of modified navigation versus conventional techniques; on reducing operation, fluoroscopy times and effective radiation dose.
RESULTS
Fifteen studies (ten prospectives, and five retrospectives) were included for quantitative analysis. PELD recorded a shorter operation time (by 126.3min, p<0.001) and fluoroscopic time (by 22.9s, p=0.3) than MIS-TLIF. The highest radiation dose/case (μSV) for both techniques were recorded at the surgeon's: finger, chest, neck and eye. The effective dose for MIS-TLIF was 30μSV higher than PELD. Modified navigation techniques recorded a shorter operation time (by 15.9min, p=0.3); fluoroscopy time (by 289.8s, p=0.3); effective radiation dose (by 169.5μSV, p=0.3) than conventional fluoroscopy methods.
DISCUSSION
This systematic literature review showed that although navigation assisted fluoroscopy techniques are superior to conventional methods in minimising radiation exposure, lack of statistical significance warrants future randomised controlled trials, to solidify their efficacy in reducing radiation related hazards.
Topics: Diskectomy, Percutaneous; Humans; Intervertebral Disc Displacement; Lumbar Vertebrae; Minimally Invasive Surgical Procedures; Radiation Exposure; Spinal Fusion; Surgeons; Treatment Outcome
PubMed: 33333283
DOI: 10.1016/j.otsr.2020.102795