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Meta-Analysis
. 2019 Feb 15;39(2):BSR20181866.
doi: 10.1042/BSR20181866. Print 2019 Feb 28.

Percutaneous endoscopic transforaminal discectomy precedes interlaminar discectomy in the efficacy and safety for lumbar disc herniation

Peng Chen  1 , Yihe Hu  2 , Zhanzhan Li  3
Affiliations
Meta-Analysis

Percutaneous endoscopic transforaminal discectomy precedes interlaminar discectomy in the efficacy and safety for lumbar disc herniation

Peng Chen et al. Biosci Rep. .

Abstract

We searched several databases from the times of their inception to 20 December 2018. Randomized controlled trials and cohort studies that compared percutaneous endoscopic transforaminal discectomy (PETD) with percutaneous endoscopic interlaminar discectomy (PEID) were identified. We used a random-effects model to calculate the relative risks (RRs) of, and standardized mean differences (SMDs) between the two techniques, with 95% confidence intervals (CIs). Twenty-six studies with 3294 patients were included in the final analysis. Compared with PEID, PETD reduced the short-term (SMD -0.68; 95% CI -1.01, -0.34; P=0.000) and long-term (SMD -0.47; 95% CI -0.82, -0.12; P=0.000) visual analog scale scores, blood loss (SMD -4.75; 95% CI -5.80, -3.71; P=0.000), duration of hospital stay (SMD -1.86; 95% CI -2.36, -1.37; P=0.000), and length of incision (SMD -3.93; 95% CI -5.23, -2.62; P=0.000). However, PEID was associated with a lower recurrence rate (P=0.035) and a shorter operative time (P=0.014). PETD and PEID afforded comparable excellent- and good-quality data, long- and short-term Oswestry disability index (ODI) scores, and complication rates. PETD treated lumbar disc herniation (LDH) more effectively than PEID. Although PETD required a longer operative time, PETD was as safe as PEID, and was associated with less blood loss, a shorter hospital stay, and a shorter incision. PETD is the best option for patients with LDH.

Keywords: Lumbar disc herniation; meta-analysis; microendoscopic discectomy; percutaneous endoscopic lumbar discectomy.

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Conflict of interest statement

The authors declare that there are no competing interests associated with the manuscript.

Figures

Figure 1
Figure 1. Flow chart of study selection
Figure 2
Figure 2. Comparison of short-term VAS between PETD and PEID
Figure 3
Figure 3. Comparison of long-term VAS between PETD and PEID.
Figure 4
Figure 4. Forest plot for short-term and long-term ODI between PETD and PEID
Comparison of short-term (A) and long-term (B) ODI between PETD and PEID.
Figure 5
Figure 5. Forest plot for clinical outcomes
Comparisons of clinical outcomes between PETD and PEID: (A) excellent and good rate; (B) complication rate; (C) recurrence and residue rate.
Figure 6
Figure 6. Forest plot for symptoms
Comparisons of duration of operation (A), blood loss (B), length of incision (C), and length of hospital stay (D).
See this image and copyright information in PMC

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