title: Percutaneous endoscopic lumbar discectomy for lumbar disc herniation.
abstract: This study aims to compare the advantages and disadvantage of percutaneous endoscopic lumbar discectomy (PELD) and standard discectomy (SD) for the treatment of lumbar intervertebral disc herniation (LDH). We searched in MEDLINE, EMBASE, PubMed, Web of Science and Cochrane databases for relevant trials that compare PELD and SD for the treatment of LDH. The Cochrane Collaboration's Revman 5.3 software was used for data analyses. This meta-analysis compiled 1301 cases from four random controlled trials and three retrospective studies. Compared with SD, PELD showed a shorter operative time (mean difference (MD)=-18.68, 95% confidence interval (CI): -24.92 to -12.43; p<0.00001), less blood loss (MD=-64.88, 95% CI: -114.51 to -15.25, p<0.0001), shorter hospital stay (MD=-3.51, 95% CI: -4.93 to -2.08, p<0.00001), and shorter mean disability period (MD=-34.34, 95% CI: -53.90 to -14.77, p<0.006). However, there were no significant differences in the visual analogue scale (VAS) scores at the final follow up (MD=-0.23, 95% CI: -0.53 to 0.07, p=0.14), Macnab criteria at the final follow up (MD=1.04, 95% CI: 0.72 to 1.50, p=0.82), complications (RR=0.76, 95% CI: 0.40 to 1.43, p=0.39), recurrence rate (risk ratio (RR)=1.00, 95% CI: 0.61 to 1.64, p=1) and reoperation rate (RR=1.40, 95% CI: 0.90 to 2.16, p=0.13). In conclusion, despite PELD showing significant benefit in short term outcomes such as hospital course and mean disability period, similar clinical efficacy and long term outcomes were observed when compared to SD. Therefore, we suggest that PELD can be a feasible alternative to the conventional posterior approach for the LDH depending on surgeon preference and indication. High-quality randomized controlled trials with sufficient large sample sizes necessary further confirm these results.
authors.affiliation: Department of Spinal Surgery, East Hospital, Tongji University School of Medicine, 150 JiMo Road, Shanghai 200120, China. Electronic address: 1013yxs@sina.com.
authors.forename: Xinhua
authors.initials: X
authors.lastname: Li
authors.affiliation: Department of Spinal Surgery, East Hospital, Tongji University School of Medicine, 150 JiMo Road, Shanghai 200120, China.
authors.forename: Yingchao
authors.initials: Y
authors.lastname: Han
authors.affiliation: Department of Traditional Chinese Medicine, Tongji Hospital of Tongji University Branch, Shanghai, China.
authors.forename: Zhi
authors.initials: Z
authors.lastname: Di
authors.affiliation: Department of Spinal Surgery, East Hospital, Tongji University School of Medicine, 150 JiMo Road, Shanghai 200120, China.
authors.forename: Jian
authors.initials: J
authors.lastname: Cui
authors.affiliation: Department of Spinal Surgery, East Hospital, Tongji University School of Medicine, 150 JiMo Road, Shanghai 200120, China.
authors.forename: Jie
authors.initials: J
authors.lastname: Pan
authors.affiliation: Department of Spinal Surgery, East Hospital, Tongji University School of Medicine, 150 JiMo Road, Shanghai 200120, China.
authors.forename: MingJie
authors.initials: M
authors.lastname: Yang
authors.affiliation: Department of Traumatology, East Hospital, Tongji University School of Medicine, 150 JiMo Road, Shanghai 200120, China.
authors.forename: Guixin
authors.initials: G
authors.lastname: Sun
authors.affiliation: Department of Spinal Surgery, East Hospital, Tongji University School of Medicine, 150 JiMo Road, Shanghai 200120, China.
authors.forename: Jun
authors.initials: J
authors.lastname: Tan
authors.affiliation: Department of Spinal Surgery, East Hospital, Tongji University School of Medicine, 150 JiMo Road, Shanghai 200120, China. Electronic address: liliju@163.com.
authors.forename: Lijun
authors.initials: L
authors.lastname: Li
mesh_terms: D001182:Arthroscopy / Q000379:methods*; D017587:Diskectomy, Percutaneous / Q000379:methods*; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000601:surgery*; D008159:Lumbar Vertebrae / Q000601:surgery*
keywords: Lumbar intervertebral disc herniation; Meta analysis; Percutaneous endoscopic lumbar discectomy