Percutaneous Transforaminal Endoscopic Discectomy Versus Open Microdiscectomy for Lumbar Disc Herniation
Spine, vol. 46, pp. 538–549
Abstract
STUDY DESIGN: Systematic review and meta-analysis. OBJECTIVE: To give a systematic overview of effectiveness of percutaneous transforaminal endoscopic discectomy (PTED) compared with open microdiscectomy (OM) in the treatment of lumbar disk herniation (LDH). SUMMARY OF BACKGROUND DATA: The current standard procedure for the treatment of sciatica caused by LDH, is OM. PTED is an alternative surgical technique which is thought to be less invasive. It is unclear if PTED has comparable outcomes compared with OM. METHODS: Multiple online databases were systematically searched up to April 2020 for randomized controlled trials and prospective studies comparing PTED with OM for LDH. Primary outcomes were leg pain and functional status. Pooled effect estimates were calculated for the primary outcomes only and presented as standard mean differences (SMD) with their 95% confidence intervals (CI) at short (1-day postoperative), intermediate (3-6 months), and long-term (12 months). RESULTS: We identified 2276 citations, of which eventually 14 studies were included. There was substantial heterogeneity in effects on leg pain at short term. There is moderate quality evidence suggesting no difference in leg pain at intermediate (SMD 0.05, 95% CI -0.10-0.21) and long-term follow-up (SMD 0.11, 95% CI -0.30-0.53). Only one study measured functional status at short-term and reported no differences. There is moderate quality evidence suggesting no difference in functional status at intermediate (SMD -0.09, 95% CI -0.24-0.07) and long-term (SMD -0.11, 95% CI -0.45-0.24). CONCLUSION: There is moderate quality evidence suggesting no difference in leg pain or functional status at intermediate and long-term follow-up between PTED and OM in the treatment of LDH. High quality, robust studies reporting on clinical outcomes and cost-effectiveness on the long term are lacking.Level of Evidence: 2.
Authors 9
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Pravesh Shankar Gadjradj corresponding Aachen Department of Neurosurgery, Leiden University Medical Center
Leiden University Medical Center
Affiliation as printed
Department of Neurosurgery, Leiden University Medical Center, University Neurosurgical Center Holland (UNCH), Leiden, the Netherlands
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Affiliation as printed
Department of Neurosurgery, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands
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Leiden University Medical Center
Affiliation as printed
Department of Neurosurgery, Leiden University Medical Center, University Neurosurgical Center Holland (UNCH), Leiden, the Netherlands
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Affiliation as printed
Department of Orthopedic Surgery, Rijnstate Hospital, Arnhem, the Netherlands
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Affiliation as printed
Centre for Pain, Health and Lifestyle, Australia
School of Public Health, University of Sydney, Camperdown, Australia
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Amsterdam Movement Sciences · Vrije Universiteit Amsterdam
Affiliation as printed
Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
Faculty Behavioral & Movement Sciences, Amsterdam Movement Sciences Research Institute, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
Relevant financial activities outside the submitted work: grants, payment for lecture
Supplemental digital content is available for this article. Direct URL citations appearing in the printed text are provided in the HTML and PDF version of this article on the journal's Web site (www.spinejournal.com)
The manuscript submitted does not contain information about medical device(s)/drug(s)
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Leiden University Medical Center
Affiliation as printed
Department of Neurosurgery, Leiden University Medical Center, University Neurosurgical Center Holland (UNCH), Leiden, the Netherlands
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Leiden University Medical Center
Affiliation as printed
Department of Neurosurgery, Leiden University Medical Center, University Neurosurgical Center Holland (UNCH), Leiden, the Netherlands
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Amsterdam Movement Sciences · Vrije Universiteit Amsterdam
Affiliation as printed
Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
Faculty Behavioral & Movement Sciences, Amsterdam Movement Sciences Research Institute, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
Relevant financial activities outside the submitted work: grants, payment for lecture
Supplemental digital content is available for this article. Direct URL citations appearing in the printed text are provided in the HTML and PDF version of this article on the journal's Web site (www.spinejournal.com)
The manuscript submitted does not contain information about medical device(s)/drug(s)
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