J Korean Neurosurg Soc.  2020 Jul;63(4):477-486. 10.3340/jkns.2019.0229.

Is It Possible to Replace Microendoscopic Discectomy with Percutaneous Transforaminal Discectomy for Treatment of Lumbar Disc Herniation? A Meta-Analysis Based on Recurrence and Revision Rate

• Zhao Xm
• Yuan Ql
• Liu L
• Shi Ym
• Zhang Yg

• KMID: 2504642
• DOI: http://doi.org/10.3340/jkns.2019.0229

Abstract

Objectives
: Due to recent developments and the wide application of percutaneous transforaminal discectomy (PTED) in China, we herein compare its clinical effects with microendoscopic discectomy (MED) for the treatment of lumbar disc herniation in terms of recurrence and revision rates.
Methods
: Six databases, namely, PubMed, EMBASE, Cochrane Library, Ovid, China National Knowledge Infrastructure and Wanfang, were searched by computer. The literature was screened according to inclusion and exclusion criteria, and the quality of the included literature was evaluated. After extracting the data from the papers, Review Manager 5.2 software (Cochrane Collaboration, Oxford, UK) was applied to analyze these data. Finally, sensitivity and publication bias analyses of the results were conducted.
Results
: A total of 12 studies consisting of 2400 patients were included in this meta-analysis. A comparison of PTED with MED revealed higher postoperative recurrence and postoperative revision rates for PTED (odds ratio [OR] recurrence, 1.60; 95% confidence interval [CI], 1.01 to 2.53; p=0.05 and OR revision, 1.77; 95% CI, 1.18 to 2.64, p=0.006).
Conclusion
: PTED has a number of advantages because it is a minimally invasive surgery, but its recurrence and revision rates are higher than MED. Therefore, MED should not be completely replaced by PTED.

Keyword

Herniated disc; Microendoscopic discectomy; Percutaneous transforaminal discectomy; Reoperation; Recurrence; Meta-analysis

Figure

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  Fig. 1. Flow chart of study selection. PTED : percutaneous transforaminal discectomy, RCT : randomized controlled trial.

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  Fig. 2. Meta-analysis for recurrence rate between PTED and MED. PTED : percutaneous transforaminal discectomy, MED : microendoscopic discectomy, OR : odds ratio, M-H : mantel-hensel test, CI : confidence interval.

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  Fig. 3. Meta-analysis for revision rate between PTED and MED. PTED : percutaneous transforaminal discectomy, MED : microendoscopic discectomy, OR : odds ratio, M-H : mantel-hensel test, CI : confidence interval.

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  Fig. 4. Funnel plot of PTED and MED for recurrence rate. SE : standard error, OR : odds ratio, PTED : percutaneous transforaminal discectomy, MED : microendoscopic discectomy.

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  Fig. 5. Funnel plot of PTED and MED for revision rate. SE : standard error, OR : odds ratio, PTED : percutaneous transforaminal discectomy, MED : microendoscopic discectomy.

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