Percutaneous Transforaminal Endoscopic Discectomy Versus Open Microdiscectomy for Lumbar Disc Herniation: A Systematic Review and Meta-analysis

Pravesh S. Gadjradj, Biswadjiet S. Harhangi, Jantijn Amelink, Job van Susante, Steven Kamper, Maurits van Tulder, Wilco C. Peul, Carmen Vleggeert-Lankamp, Sidney M. Rubinstein

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Abstract

STUDY DESIGN: Systematic review and meta-analysis.

OBJECTIVE: To give a systematic overview of effectiveness of percutaneous transforaminal endoscopic discectomy (PTED) compared to 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 to 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 (one-day post-operative), 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).

CONCLUSIONS: 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.

Original languageEnglish
Pages (from-to)538-549
Number of pages12
JournalSPINE
Volume46
Issue number8
Early online date7 Dec 2020
DOIs
Publication statusPublished - 15 Apr 2021

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