title: Lumbar microdiscectomy complication rates: a systematic review and meta-analysis.
abstract: OBJECT Lumbar microdiscectomy and its various minimally invasive surgical techniques are seeing increasing popularity, but a systematic review of their associated complications has yet to be performed. The authors sought to identify all prospective clinical studies reporting complications associated with lumbar open microdiscectomy, microendoscopic discectomy (MED), and percutaneous microdiscectomy. METHODS The authors conducted MEDLINE, Scopus, Web of Science, and Embase database searches for randomized controlled trials and prospective cohort studies reporting complications associated with open, microendoscopic, or percutaneous lumbar microdiscectomy. Studies with fewer than 10 patients and published before 1990 were excluded. Overall and interstudy median complication rates were calculated for each surgical technique. The authors also performed a meta-analysis of the reported complications to assess statistical significance across the various surgical techniques. RESULTS Of 9504 articles retrieved from the databases, 42 met inclusion criteria. Most studies screened were retrospective case series, limiting the number of studies that could be included. A total of 9 complication types were identified in the included studies, and these were analyzed across each of the surgical techniques. The rates of any complication across the included studies were 12.5%, 13.3%, and 10.8% for open, MED, and percutaneous microdiscectomy, respectively. New or worsening neurological deficit arose in 1.3%, 3.0%, and 1.6% of patients, while direct nerve root injury occurred at rates of 2.6%, 0.9%, and 1.1%, respectively. Hematoma was reported at rates of 0.5%, 1.2%, and 0.6%, respectively. Wound complications (infection, dehiscence, orseroma) occurred at rates of 2.1%, 1.2%, and 0.5%, respectively. The rates of recurrent disc complications were 4.4%, 3.1%, and 3.9%, while reoperation was indicated in 7.1%, 3.7%, and 10.2% of operations, respectively. Meta-analysis calculations revealed a statistically significant higher rate of intraoperative nerve root injury following percutaneous procedures relative to MED. No other significant differences were found. CONCLUSIONS This review highlights complication rates among various microdiscectomy techniques, which likely reflect real-world practice and conceptualization of complications among physicians. This investigation sets the framework for further discussions regarding microdiscectomy options and their associated complications during the informed consent process.
authors.affiliation: School of Medicine and.
authors.forename: Michael F
authors.initials: MF
authors.lastname: Shriver
authors.affiliation: Department of Physiology and Biophysics, Case Western Reserve University;
authors.forename: Jack J
authors.initials: JJ
authors.lastname: Xie
authors.affiliation: School of Medicine and.
authors.forename: Erik Y
authors.initials: EY
authors.lastname: Tye
authors.affiliation: Department of Neurosurgery.
authors.forename: Benjamin P
authors.initials: BP
authors.lastname: Rosenbaum
authors.affiliation: Department of Neurosurgery.|Center for Spine Health, and.
authors.forename: Varun R
authors.initials: VR
authors.lastname: Kshettry
authors.affiliation: Department of Neurosurgery.|Center for Spine Health, and.
authors.forename: Edward C
authors.initials: EC
authors.lastname: Benzel
authors.affiliation: Center for Spine Health, and.|Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Thomas E
authors.initials: TE
authors.lastname: Mroz
mesh_terms: D017586:Diskectomy / Q000009:adverse effects*; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000601:surgery*; D008159:Lumbar Vertebrae / Q000601:surgery; D011183:Postoperative Complications / Q000453:epidemiology* / Q000209:etiology*
keywords: IQR = interquartile range; MED = microendoscopic discectomy; MIS = minimally invasive surgical; PCS = prospective cohort study; PRISMA = Preferred Reporting Items for Systematic Reviews and Meta-Analyses; RCT = randomized controlled trial; complications; lumbar microdiscectomy; meta-analysis; microendoscopic discectomy; percutaneous discectomy; systematic review