scholarly journals Comparison of 7 Surgical Interventions for Lumbar Disc Herniation: A Network Meta-analysis

2017 ◽  
Vol 6 (20;6) ◽  
pp. E863-E871
Author(s):  
Lin Cai
Keyword(s):  
Success Rate ◽  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Complication Rate ◽  
Lumbar Disc ◽  
Meta Analysis ◽  
Reoperation Rate ◽  
Controlled Trials ◽  
Cochrane Central Register ◽  
Surgical Interventions

Background: The number of interventions on intervertebral discs rapidly increased and the treatment options for lumbar disc surgery quickly evolved. It is important that the safety and efficacy of all new innovative procedures be compared with currently accepted forms of treatment; however, the previous pairwise meta-analyses could not develop the hierarchy of these treatments. Objectives: The purpose of the study is to perform a network meta-analysis to evaluate the clinical results of 7 surgical interventions for the treatment of lumbar disc herniation. Study Design: Network meta-analysis of randomized controlled trials (RCTs) for multiple treatment comparisons of lumbar disc herniation. Methods: We performed a Bayesian-framework network meta-analysis of RCTs to compare 7 surgical interventions for people with lumbar disc herniation. The eligible RCTs were identified by searching Embase, Pubmed, the Cochrane Central Register of Controlled Trials (CENTRAL), and Google scholar. Data from 3 outcomes (success, complications, and reoperation rate) were independently extracted by 2 authors. Results: A total of 29 RCTs including 3,146 participants were finally included into this article. Our meta-analysis provides hierarchies of these 7 interventions. For the success rate the rank probability (from best to worst): percutaneous endoscopic lumber discectomy (PELD) > standard open discectomy (SOD) > standard open microsurgical discectomy (SOMD) > chemonucleolysis (CN) > microendoscopic discectomy (MED) > percutaneous laser disc decompression (PLDD) > automated percutaneous lumber discectomy (APLD). For the complication rate the rank probability (from best to worst): PELD > SOMD > SOD > MED > PLDD > CN > APLD. For the reoperation rate the rank probability (from best to worst): SOMD > SOD > MED > PLDD > PELD > CN > APLD. Limitations: The limitations of this network meta-analysis include the range of study populations and inconformity of the follow-up times and outcome measurements. Conclusions: This meta-analysis provides evidence that PELD might be the best choice to increase the success rate and decrease the complication rate, moreover SOMD might be the best option to drop the reoperation rate. APLD might lead to the lowest success rate and the highest complication and reoperation rate. Higher quality RCTs and direct head to head trials are needed to confirm these results.

scholarly journals Incidence of Spontaneous Resorption of Lumbar Disc Herniation: A Meta-Analysis

2017 ◽  
Vol 1 (21;1) ◽  
pp. E45-E52 ◽  
Author(s):  
Hong Jiang
Keyword(s):  
Systematic Review ◽  
Chinese Medicine ◽  
Traditional Chinese Medicine ◽  
Conservative Treatment ◽  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Lumbar Disc ◽  
Meta Analysis ◽  
Controlled Trials ◽  
Randomized Controlled

Background: Lumbar disc herniation (LDH), a common disease, is often treated conservatively, frequently resulting in spontaneous resorption of the herniated disc. The incidence of this phenomenon, however, remains unknown. Objective: To analyze the incidence of spontaneous resorption after conservative treatment of LDH using computed tomography and magnetic resonance imaging. Study Design: Meta-analysis and systematic review of cohort studies. Setting: The work was performed at The Suzhou Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine. Methods: We initiated a search for the period from January 1990 to December 2015 using PubMed, Embase, and the Cochrane Library. Two independent reviewers examined the relevant reports. The references from these reports were also searched for additional trials using the criteria established in the PRISMA statement. Results: Our results represent the pooled results from 11 cohort studies. The overall incidence of spontaneous resorption after LDH was 66.66% (95% CI 51% – 69%). The incidence in the United Kingdom was 82.94% (95% CI 63.77% – 102.11%). The incidence in Japan was 62.58% (95% CI 55.71% – 69.46%). Limitations: Our study was limited because there were few sources from which to extract data, either in abstracts or published studies. There were no randomized, controlled trials that met our criteria. Conclusions: The phenomenon of LDH reabsorption is well recognized. Because its overall incidence is now 66.66% according to our results, conservative treatment may become the first choice of treatment for LDH. More large-scale, double-blinded, randomized, controlled trials are necessary to study the phenomenon of spontaneous resorption of LDH. Key words: Lumbar, disc herniation, spontaneous resorption, conservative treatment, incidence, country, meta-analysis, systematic review, observational studies, study designs

scholarly journals Discectomy Combined with Annulus Fibrosus Repair for the Treatment of Lumbar Disc Herniation: A Bayesian analysis of Random Controlled Trials

2020 ◽  
Author(s):  
Jinlong Hu ◽  
Jianzhong Bai ◽  
Xueqiang Shi ◽  
Wenyong Fei ◽  
Hua Wang
Keyword(s):  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Annulus Fibrosus ◽  
Lumbar Disc ◽  
Meta Analysis ◽  
Operation Time ◽  
Reoperation Rate ◽  
Intraoperative Blood Loss ◽  
Surgical Incision ◽  
Repair Group

Abstract Objective To investigate clinical effects of discectomy combined with annulus fibrosus (AF) repair for the treatment of lumbar disc herniation. Methods We searched PubMed, Embase, Web of Science, CNKI and WanFang data for studies evaluating discectomy combined with AF repair and discectomy for the treatment lumbar disc herniation. Two reviewers selected studies, assessed quality, and extracted data. This meta-analysis was performed to calculate the weighted mean difference (WMD), risk ratios (RRs), and 95% confidence intervals (CIs). Results Six randomized controlled trials (RCTs) were included in the meta-analysis. The pooled results suggested that the recurrence rate and reoperation rate in the non-repair group versus those in the repair group [RR= 2.64, 95% confidence interval (CI) 1.09, 6.41], [RR=1.33, CI 0.85, 2.10], respectively. The rate of Visual analogue scale (VAS) relief in the repair group was significantly better than in non-repair group [WMD=0.23, CI 0.04, 0.42], and did not increase the incidence of postoperative complications. There were no significant differences between the two surgical procedures in the Oswestry disability index (ODI) reduction [WMD=-0.18, CI -1.50, 1.14], intraoperative blood loss [WMD = -1.23, CI -4.46, 2.00] and the length of the surgical incision [WMD = 0.08, CI -0.01, 0.18]. However, the operation time of the repair group was slightly longer than non-repair group [WMD =6.73, CI 2.80, 10.66]. Conclusion Discectomy combined with AF repair is superior to discectomy regarding postoperative recurrence rate and postoperative pain relief, but the operation time is slightly longer than the latter. There is no significant difference in reoperation rate, intraoperative blood loss, length of the surgical incision, postoperative complication rate, and reduction in ODI between the two surgical procedures.

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

2021 ◽  
Vol 8 ◽  
Author(s):  
Fei-Long Wei ◽  
Tian Li ◽  
Quan-You Gao ◽  
Yi Yang ◽  
Hao-Ran Gao ◽  
...  
Keyword(s):  
Blood Loss ◽  
Lumbar Disc ◽  
Meta Analysis ◽  
Operation Time ◽  
Lumbar Discectomy ◽  
Controlled Trials ◽  
Cochrane Central Register ◽  
Complication Rates ◽  
Surgical Interventions ◽  
Operative Complication

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.

scholarly journals Comparison of Different Operative Approaches for Lumbar Disc Herniation: A Network Meta- Analysis and Systematic Review

2021 ◽  
pp. E381-E392
Keyword(s):  
Systematic Review ◽  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Lumbar Disc ◽  
Meta Analysis ◽  
Reoperation Rate ◽  
Cochrane Library ◽  
Surgical Approaches ◽  
Complication Rates ◽  
Dural Tear

BACKGROUND: New approaches and technologies can be beneficial for patients but also bring corresponding complications. Traditional pairwise meta-analyses cannot be used to comprehensively rank all surgical approaches. OBJECTIVES: The purpose of this systematic review and network meta-analysis (NMA) was to compare the outcomes of different surgical approaches for lumbar disc herniation (LDH). STUDY DESIGN: NMA of randomized controlled trials (RCTs) for multiple treatment comparisons of LDH. METHODS: The PubMed, Embase, MEDLINE, Ovid, and Cochrane Library databases were searched for RCTs comparing different surgical approaches for patients with LDH from inception to February 10, 2020. The Markov chain Monte Carlo methods were used to perform a hierarchical Bayesian NMA in WinBUGS version 1.4.3 using a random effects consistency model. The primary outcomes were disability and pain intensity. The secondary outcomes were complications and reoperation. The PROSPERO number was CRD42020179406. RESULTS: A total of 22 trials including 2529 patients and all 5 different approaches (open discectomy or microdiscectomy [OD/MD], microendoscopic discectomy [MED], percutaneous endoscopic discectomy [PED], percutaneous discectomy [PD], and tubular discectomy [TD]) were retrospectively retrieved. PED had the best efficacy in improving patients’ dysfunction with no statistical significance (probability = 50%). PD was significantly worse than OD/MD, MED, and PED in relieving patients’ pain (standardized mean differences: 0.87 [0.03, 1.76], 0.94 [0.06, 1.88], and 1.02 [0.13, 1.94], respectively). There was no statistically significant difference between any 2 surgical approaches in dural tear; intraoperative, postoperative, and overall complications; or reoperation rate. PED had the lowest dural tear rate and the lowest intraoperative and overall complication rates (probability = 51%, 67%, and 33%, respectively). TD had the lowest postoperative complication and reoperation rates (probability = 35% and 39%, respectively). LIMITATIONS: The limitations of this NMA include the inconsistent follow-up times, the criteria for complications, and the reasons for reoperation. CONCLUSIONS: Compared with other approaches used to treat LDH, PED had the best safety and efficacy in general, and TD had the lowest reoperation rate. Finally, we recommended PED for LDH. KEY WORDS: Lumbar disc herniation, network meta-analysis, minimally invasive surgery, surgical approaches, efficacy, safety

Discectomy Combined with Annulus Fibrosus Repair for the Treatment of Lumbar Disc Herniation: A Bayesian analysis of Random Controlled Trials

2020 ◽  
Author(s):  
Jinlong Hu ◽  
Jianzhong Bai ◽  
Xueqiang Shi ◽  
Wenyong Fei ◽  
Hua Wang
Keyword(s):  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Annulus Fibrosus ◽  
Lumbar Disc ◽  
Meta Analysis ◽  
Operation Time ◽  
Reoperation Rate ◽  
Intraoperative Blood Loss ◽  
Surgical Incision ◽  
Repair Group

Abstract Objective To investigate clinical effects of discectomy combined with annulus fibrosus (AF) repair for the treatment of lumbar disc herniation. Methods We searched PubMed, Embase, Web of science, CNKI and WanFang data for studies evaluating discectomy combined with AF repair and discectomy for the treatment lumbar disc herniation. Two reviewers selected studies, assessed quality and extracted data. This meta-analysis was performed to calculate weighted mean difference (WMD), risk ratios (RRs), and 95% confidence intervals (CIs). Results Seven randomized controlled trials (RCTs) were included in the meta-analysis. The pooled results suggested that the recurrence rate and reoperation rate in the non-repair group higher than those in the repair group [RR= 2.16, 95% confidence interval (CI) 1.50, 3.10], [RR=1.74, CI 1.22, 2.49], respectively. The rate of Visual analogue scale (VAS) relief in the repair group was significantly better than in non-repair group [WMD=0.22, CI 0.06, 0.37], and did not increase the incidence of postoperative complications. There were no significant differences between the two surgical procedures in the Oswestry disability index (ODI) reduction [WMD=0.36, CI -0.79, 1.50], intraoperative blood loss [WMD = -1.23, CI -4.46, 2.00] and the length of the surgical incision [WMD = 0.08, CI -0.01, 0.18]. However, the operation time of the repair group was slightly longer than non-repair group [WMD =6.73, CI 2.80, 10.66]. Conclusion Discectomy combined with AF repair is superior to discectomy regarding postoperative recurrence rate, reoperation rate and postoperative pain relief, but the operation time is slightly longer than the latter. There is no significant difference in intraoperative blood loss, length of surgical incision, postoperative complication rate and reduction in ODI between the two surgical procedures.

Recurrence Rate of Lumbar Disc Herniation After Standard Discectomy and Microdiscectomy: A 5-Year Study

2019 ◽  
Vol 12 (2) ◽  
pp. 139-146
Author(s):  
Mladen E. Ovcharov ◽  
Iliya V. Valkov ◽  
Milan N. Mladenovski ◽  
Nikolay V. Vasilev
Keyword(s):  
Recurrence Rate ◽  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Lumbar Disc ◽  
Surgical Techniques ◽  
Reoperation Rate ◽  
University Hospital ◽  
Recurrence Rates ◽  
Chi Square ◽  
Common Procedure

Summary Lumbar disc herniation (LDH) is the most common pathology in young people, as well as people of active age. Despite sophisticated and new minimally invasive surgical techniques and approaches, reoperations for recurrent lumbar disc herniation (rLDH) could not be avoided. LDH recurrence rates, reported in different studies, range from 5 to 25%. The purpose of this study was to estimate the recurrence rates of LDH after standard discectomy (SD) and microdiscectomy (MD), and compare them to those reported in the literature. Retrospectively, operative reports for the period 2012-2017 were reviewed on LDH surgeries performed at the Neurosurgery Clinic of Dr Georgi Stranski University Hospital in Pleven. Five hundred eighty-nine single-level lumbar discectomies were performed by one neurosurgeon. The diagnoses of recurrent disc herniation were based on the development of new symptoms and magnetic resonance/computed tomography (MRI/CT) images showing compatible lesions in the same lumbar level as the primary lumbar discectomies. The recurrence rate was determined by using chi-square tests and directional measures. SD was the most common procedure (498 patients) followed by MD (91 patients). The cumulative reoperation rate for rLDH was 7.5%. From a total number of reoperations, 26 were males (59.1%) and 18 were females (40.9%). Reoperation rates were 7.6% and 6.6% after SD and MD respectively. The recurrence rate was not significantly higher for SD. Our recurrence rate was 7.5%, which makes it comparable with the rates of 5-25% reported in the literature.

scholarly journals A Comparison of Percutaneous Endoscopic Lumbar Discectomy and Open Lumbar Microdiscectomy for Lumbar Disc Herniation in the Korean: A Meta-Analysis

2018 ◽  
Vol 2018 ◽  
pp. 1-8 ◽  
Author(s):  
Manyoung Kim ◽  
Sol Lee ◽  
Hyeun-Sung Kim ◽  
Sangyoon Park ◽  
Sang-Yeup Shim ◽  
...  
Keyword(s):  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Lumbar Disc ◽  
Meta Analysis ◽  
Lumbar Discectomy ◽  
Percutaneous Endoscopic Lumbar Discectomy ◽  
Lumbar Microdiscectomy ◽  
Surgical Methods ◽  
Endoscopic Lumbar Discectomy

Background. Among the surgical methods for lumbar disc herniation, open lumbar microdiscectomy is considered the gold standard. Recently, percutaneous endoscopic lumbar discectomy is also commonly performed for lumbar disc herniation for its various strong points. Objectives. The present study aims to examine whether percutaneous endoscopic lumbar discectomy and open lumbar microdiscectomy show better results as surgical treatments for lumbar disc herniation in the Korean population. Methods. In the present meta-analysis, papers on Korean patients who underwent open lumbar microdiscectomy and percutaneous endoscopic lumbar discectomy were searched, both of which are surgical methods to treat lumbar disc herniation. The papers from 1973, when percutaneous endoscopic lumbar discectomy was first introduced, to March 2018 were searched at the databases of MEDLINE, EMBASE, PubMed, and Cochrane Library. Results. Seven papers with 1254 patients were selected. A comparison study revealed that percutaneous endoscopic lumbar discectomy had significantly better results than open lumbar microdiscectomy in the visual analogue pain scale at the final follow-up (leg: mean difference [MD]=-0.35; 95% confidence interval [CI]=-0.61, -0.09; p=0.009; back: MD=-0.79; 95% confidence interval [CI]=-1.42, -0.17; p=0.01), Oswestry Disability Index (MD=-2.12; 95% CI=-4.25, 0.01; p=0.05), operation time (MD=-23.06; 95% CI=-32.42, -13.70; p<0.00001), and hospital stay (MD=-4.64; 95% CI=-6.37, -2.90; p<0.00001). There were no statistical differences in the MacNab classification (odds ratio [OR]=1.02; 95% CI=0.71, 1.49; p=0.90), complication rate (OR=0.72; 95% CI=0.20, 2.62; p=0.62), recurrence rate (OR=0.83; 95% CI=0.50, 1.38; p=0.47), and reoperation rate (OR=1.45; 95% CI=0.89, 2.35; p=0.13). Limitations. All 7 papers used for the meta-analysis were non-RCTs. Some differences (type of surgery (primary or revisional), treatment options before the operation, follow-up period, etc.) existed depending on the selected paper, and the sample size was small as well. Conclusion. While percutaneous endoscopic lumbar discectomy showed better results than open lumbar microdiscectomy in some items, open lumbar microdiscectomy still showed good clinical results, and it is therefore reckoned that a randomized controlled trial with a large sample size would be required in the future to compare these two surgical methods.

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