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Meta-analysis of percutaneous transforaminal endoscopic discectomy vs. fenestration discectomy in the treatment of lumbar disc herniation

Metaanalyse der perkutanen transforaminalen endoskopischen Diskektomie im Vergleich zur Fensterungsdiskektomie in der Behandlung des lumbalen Bandscheibenvorfalls

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Abstract

Objective

The aim of this study was to systematically review the efficacy of percutaneous transforaminal endoscopic discectomy (PTED) and fenestration discectomy (FD) in the treatment of lumbar disc herniation (LDH).

Material and methods

We performed a systematic search in MEDLINE, EMBASE, PubMed, Web of Science, Cochrane databases, Chinese Biomedical Literature Database, CNKI, and Wanfang Data for all relevant studies. All statistical analyses wer performed using Review Manager version 5.3. Dichotomous data were calculated by odds ratio (OR) and continuous data were calculated by mean difference (MD) with 95% confidence intervals (CI).

Results

A total of 17 articles with 1390 study subjects were included, with 733 patients in the PTED group and 657 patients in the FD group. The results of the meta-analysis showed that postoperative the visual analog scale (VAS) score (mean difference [MD] −0.13; 95% confidence interval [CI] −0.22 to −0.03; P = 0.009) and postoperative complications (MD 0.52; 95% CI 0.26 to 1.04; P = 0.06) showed no significant differences between the PTED group and the FD group, while the PTED group had significantly better results in operation time (MD 0.47; 95% CI −11.34 to 12.28; P = 0.94), length of incision (MD −3.74; 95% CI −4.28 to −3.19; P < 0.00001), amount of bleeding (MD −63.66, 95% CI −77.65 to −49.67; P < 0.00001), time of postoperative bed rest (MD −90.19; 95% CI −106.82 to −73.56; P < 0.00001), hospitalization time (MD −5.90; 95% CI −7.21 to −4.59; P < 0.00001), and postoperative Oswestry disability index (ODI) score (MD −0.59; 95% CI −1.11 to −0.08; P = 0.02) compared with the FD group.

Conclusion

The Percutaneous transforaminal endoscopic discectomy is associated with better postoperative ODI score, better results in length of incision, lower blood loss, shorter operation time, postoperative bed time and hospitalization time. The complications did not differ significantly between PTED and FD in the treatment of lumbar disc herniation. These findings provide evidence to support PTED is efficacious for LDH; however, scar repair of a ruptured anulus fibrosus needs a long time and the patients undergoing PTED should be advised to stay in bed for a long time even if the symptoms are markedly relieved. These results are not limited to randomized controlled trials and lack data about the long-term outcome.

Zusammenfassung

Ziel

Ziel der Studie war eine systematische Übersicht der Wirksamkeit der perkutanen transforaminalen endoskopischen Diskektomie (PTED) und der Fensterungsdiskektomie (FD) in der Behandlung des lumbalen Bandscheibenvorfalls (LBV).

Material und Methoden

Wir führten eine systematische Literatursuche nach allen relevanten Studien in MEDLINE, EMBASE, PubMed, Web of Science, Cochrane-Datenbanken, Chinese Biomedical Literature Database, CNKI und Wanfang Data durch. Alle statistischen Analysen erfolgten mit dem Review Manager, Version 5.3. Bei dichotomen Daten wurde die Odds Ratio (OR) berechnet, bei kontinuierlichen Daten die Mittelwertdifferenz (MD) mit 95 %-Konfidenzintervall (KI).

Ergebnisse

Insgesamt 17 Beiträge mit 1390 Studienteilnehmern wurden eingeschlossen, darunter 733 Patienten in der PTED-Gruppe und 657 Patienten in der FD-Gruppe. Die Metaanalyse ergab, dass sich der postoperative Wert auf der visuellen Analogskala (VAS; MD −0,13; 95 %-KI −0,22 bis −0,03; P = 0,009) und die postoperativen Komplikationen (MD 0,52; 95 %-KI 0,26 bis 1,04; P = 0,06) nicht signifikant zwischen PTED- und FD-Gruppe unterschieden, während die PTED-Gruppe im Vergleich zur FD-Gruppe signifikant bessere Ergebnisse in der Operationszeit (MD 0,47; 95 %-KI −11,34 bis 12,28; P = 0,94), der Schnittlänge (MD −3,74; 95 %-KI −4,28 bis −3,19; P < 0,00001), dem Blutverlust (MD −63,66, 95 %-KI −77,65 bis −49,67; P < 0,00001), der Dauer der postoperativen Bettruhe (MD −90,19; 95 %-KI −106,82 bis −73,56; P < 0,00001), der Krankenhausverweildauer (MD −5,90; 95 %-KI −7,21 bis −4,59; P < 0,00001) und dem postoperativen Oswestry-Disability-Index(ODI)-Wert (MD −0,59; 95 %-KI −1,11 bis −0,08; P = 0,02) aufwies.

Schlussfolgerung

Die PTED ist mit einem besseren postoperativen ODI-Wert, besseren Ergebnissen bezüglich der Schnittlänge, einem geringeren Blutverlust sowie einer kürzeren Operationsdauer, postoperativen Bett ruhe und Krankenhausverweildauer assoziiert. Die Komplikationen im Rahmen der Behandlung lumbaler Bandscheibenvorfälle unterschieden sich nicht signifikant zwischen PTED und FD. Diese Ergebnisse stützen die Aussage, dass die PTED bei LBV wirksam ist. Allerdings dauert die Narbenheilung eines rupturierten Anulus fibrosus lange. Des Weiteren sollte dem Patienten nach PTED zu einer langen Bettruhe geraten werden, auch wenn die Symptome schon deutlich nachgelassen haben. Diese Ergebnisse sind durch das Fehlen randomisierter, kontrollierter Studien eingeschränkt. Des Weiteren mangelt es an Daten zum langfristigen Outcome.

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Abbreviations

FD:

Fenestration discectomy

LDH:

Lumbar disc herniation

NOS:

Newcastle-Ottawa scale

ODI:

Oswestry disability index

PELD:

Percutaneous endoscopic lumbar discectomy

PRISMA:

Preferred reporting items for systematic reviews and meta-analyses

PTED:

Percutaneous transforaminal endoscopic discectomy

TF-PELD:

Transforaminal percutaneous endoscopic lumbar discectomy

VAS:

Postoperative visual analogue score

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Funding

Dr. Nong Luming: the fifth phase project “333 Project” of Jiangsu Province in 2017 (BRA2017120), Changzhou International Scientific and Technological Cooperation Project (CZ20170021), Jiangsu Postdoctoral Research supported project (1701001 A), the Project of Invigorating Health Care through Science, Technology and Education (Jiangsu Provincial Medical Youth Talent) and Changzhou city high level health personnel training project (2016CZBJ029).

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Authors and Affiliations

  1. Department of Orthopedics, Changzhou Second People’s Hospital, Nanjing Medical University, NO. 29 XingLongXiang, ZhongLou, 213003, Changzhou, China

    Weilan Ding, Jianjian Yin, Ting Yan, Luming Nong & Nanwei Xu

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  1. Weilan Ding
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  2. Jianjian Yin
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  3. Ting Yan
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Corresponding authors

Correspondence to Ting Yan or Luming Nong.

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Conflict of interest

W. Ding, J. Yin, T. Yan, L. Nong and N. Xu declare that they have no competing interests.

This article does not contain any studies with human participants or animals performed by any of the authors.

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W. Ding and J. Yin contributed equally to this work and should be considered co-first authors.

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Ding, W., Yin, J., Yan, T. et al. Meta-analysis of percutaneous transforaminal endoscopic discectomy vs. fenestration discectomy in the treatment of lumbar disc herniation. Orthopäde 47, 574–584 (2018). https://doi.org/10.1007/s00132-018-3528-5

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