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.

OBJECTIVE

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.

MATERIALS AND

METHODS

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.

RESULTS

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).

CONCLUSIONS

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.