Eight Surgical Interventions for Lumbar Disc Herniation: A Network Meta-Analysis on Complications.

Fei-Long Wei,Yi Yang,Hao-Ran Gao,Cheng-Pei Zhou,Tian Li,Ji-Xian Qian,Quan-You Gao

doi:10.3389/fsurg.2021.679142

Fei-Long Wei, Yi Yang + Show 5 more

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https://doi.org/10.3389/fsurg.2021.679142

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Journal: Frontiers in surgery	Publication Date: Jul 20, 2021
Citations: 8	License type: CC BY 4.0

Affiliation: Air Force Medical University

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Objective: Therapeutic options for lumbar disc surgery (LDH) have been rapidly evolved worldwide. Conventional pair meta-analysis has shown inconsistent results of the safety of different surgical interventions for LDH. A network pooling evaluation of randomized controlled trials (RCT) was conducted to compare eight surgical interventions on complications for patients with LDH.Methods: PubMed, Embase, and the Cochrane Central Register of Controlled Trials (CENTRAL) were searched for RCT from inception to June 2020, with registration in PROSPERO (CRD42020176821). This study is conducted in accordance with Cochrane guidelines. Primary outcomes include intraoperative, post-operative, and overall complications, reoperation, operation time, and blood loss.Results: A total of 27 RCT with 2,948 participants and eight interventions, including automated percutaneous lumbar discectomy (APLD), chemonucleolysis (CN), microdiscectomy (MD), micro-endoscopic discectomy (MED), open discectomy (OD), percutaneous endoscopic lumbar discectomy (PELD), percutaneous laser disc decompression (PLDD), and tubular discectomy (TD) were enrolled. The pooling results suggested that PELD and PLDD are with lower intraoperative and post-operative complication rates, respectively. TD, PELD, PLDD, and MED were the safest procedures for LDH according to complications, reoperation, operation time, and blood loss.Conclusion: The results of this study provided evidence that PELD and PLDD were with lower intraoperative and post-operative complication rates, respectively. TD, PELD, PLDD, and MED were the safest procedures for LDH according to complications, reoperation, operation time, and blood loss.Systematic Review Registration: PROSPERO, identifier CRD42020176821.

Highlights

Lumbar disc herniation (LDH) is highly associated with inflammation in the context of low back pain [1]
The title and abstract of the remaining 2,359 studies were screened, and the remaining 73 papers were assessed for full text (Wei, Yang)
The cumulative probabilities of being among the lowest post-operative complication rates were: PLDD (31%), TD (24%), CN (24%), PELD (12%), MED (3%), MD (3%), OD (3%), and APLD (15%)

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Introduction

Lumbar disc herniation (LDH) is highly associated with inflammation in the context of low back pain [1]. It is a common disease in spine surgery and a primary cause of sciatica, which affects 1–2% of the general population in the USA annually [2, 3]. Large Channel PED in LSS can be treated conservatively with satisfactory results [5]. Conservative treatment as a first-line treatment can benefit most patients with LDH [6,7,8]. Surgical treatment is considered a more effective way for rapid pain relief and nerve decompression [5, 9]. Surgical methods including traditional discectomy and minimally invasive techniques have become more popular in recent years [10, 11]

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