Comparison of percutaneous endoscopic lumbar discectomy vs. minimally invasive transforaminal lumbar interbody fusion for the treatment of single-segment lumbar disc herniation: a meta-analysis.

Abstract

Percutaneous endoscopic lumbar discectomy (PELD) and minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) have been commonly demonstrated as two effective choices for the treatment of lumbar disc herniation (LDH). This meta-analysis aims to compare the effects of PELD and MIS-TLIF for the treatment of single-segment LDH. Randomized controlled trials or prospective cohort studies published from the time when databases were built to January 2022 that compared the effects of PELD and MIS-TLIF for single-segment LDH were retrieved from a comprehensive search in six electronic databases (PubMed, Web of Science, Embase databases, Cochrane Library, Google Scholar, and CNKI). All analyses were performed with RevMan 5.4 software. A total of 9 studies with 1274 patients were included in this meta-analysis. The results showed that the PELD group was associated with lower visual analog scales (VAS) score for back pain at the final follow-up (MD: 1.23; 95% CI: [0.32, 2.14], p=0.008), higher Japanese Orthopaedic Association (JOA) score (MD: 2.29; 95% CI: [1.38, 3.19], p<0.00001), lower Oswestry Disability Index (ODI) score (MD: -2.46; 95% CI: [-4.50, -0.43], p=0.02), shorter operation time at 3 months (MD: -51.77; 95% CI: [-74.63, -28.91], p<0.00001) and lesser hospital stay (MD: -5.18; 95% CI: [-6.65, -3.71], p<0.00001), and less blood loss (MD: -187.13; 95% CI: [-281.45, -92.81], p=0.0001). However, it was associated with a higher rate of recurrent disc herniation (RR: 17.66; 95% CI: [4.25,73.44], p<0.0001). There were no significant differences between PELD and MIS-TLIF in VAS leg pain (MD: 0.12; 95% CI: [-0.24, 0.49], p=0.51), and complication rate (RR: 0.71; 95% CI: [0.45, 1.12], p=0.14). The existing evidence showed that PELD had significantly better outcomes than MIS-TLIF in JOA score at six months, operation time, blood loss, and hospital stay as a procedure for LDH, but it had a higher recurrence rate than MIS-TLIF. Meanwhile, we should have a good command of the pros and cons of the two surgical methods to formulate an appropriate surgical plan for the patients.