Outcomes of endoscopic discectomy compared with open microdiscectomy and tubular microdiscectomy for lumbar disc herniations: a meta-analysis

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OBJECTIVE

Endoscopic discectomy (ED) has been advocated as a less-invasive alternative to open microdiscectomy (OM) and tubular microdiscectomy (TM) for lumbar disc herniations, with the potential to decrease postoperative pain and shorten recovery times. Large-scale, objective comparisons of outcomes between ED, OM, and TM, however, are lacking. The authors’ objective in this study was to conduct a meta-analysis comparing outcomes of ED, OM, and TM.

METHODS

The PubMed database was searched for articles published as of February 1, 2019, for comparative studies reporting outcomes of some combination of ED, OM, and TM. A meta-analysis of outcome parameters was performed assuming random effects.

RESULTS

Twenty-six studies describing the outcomes of 2577 patients were included. Estimated blood loss was significantly higher with OM than with both TM (p = 0.01) and ED (p < 0.00001). Length of stay was significantly longer with OM than with ED (p < 0.00001). Return to work time was significantly longer in OM than with ED (p = 0.001). Postoperative leg (p = 0.02) and back (p = 0.01) VAS scores, and Oswestry Disability Index scores (p = 0.006) at latest follow-up were significantly higher for OM than for ED. Serum creatine phosphokinase (p = 0.02) and C-reactive protein (p < 0.00001) levels on postoperative day 1 were significantly higher with OM than with ED.

CONCLUSIONS

Outcomes of TM and OM for lumbar disc herniations are largely equivalent. While this analysis demonstrated that several clinical variables were significantly improved in patients undergoing ED when compared with OM, the magnitude of many of these differences was small and of uncertain clinical relevance, and several of the included studies were retrospective and subject to a high risk of bias. Further high-quality prospective studies are needed before definitive conclusions can be drawn regarding the comparative efficacy of the various surgical treatments for lumbar disc herniations.

ABBREVIATIONS CPK = creatine phosphokinase; CRP = C-reactive protein; ED = endoscopic microdiscectomy; ODI = Oswestry Disability Index; OM = open microdiscectomy; TM = tubular microdiscectomy; VAS = visual analog scale.

Downloadable materials

  • Supplemental Table 1 (PDF 454 KB)

Article Information

Correspondence Albert Telfeian: The Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI. atelfeian@lifespan.org.

INCLUDE WHEN CITING Published online September 6, 2019; DOI: 10.3171/2019.6.SPINE19532.

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

© AANS, except where prohibited by US copyright law.

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Figures

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    Flowchart illustrating the study selection process.

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    Forest plots comparing operative details (operative time [A] and estimated blood loss [B]) between OM, TM, and ED. IL = interlaminar; IV = inverse variance; TF = transforaminal. Figure is available in color online only.

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    Forest plots comparing complications (all complications [A], durotomy [B], and reoperation for residual disc herniation [C]) between open microdiscectomy, tubular microdiscectomy, and endoscopic discectomy. M-H = Mantel-Haenszel. Figure is available in color online only.

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    Forest plots comparing hospital length of stay (days; A) and postoperative return to work delay (days; B) between OM, TM, and ED. Figure is available in color online only.

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    Forest plots comparing leg VAS scores (A), back VAS scores (B), and ODI (C) at latest follow-up between OM, TM, and ED. Figure is available in color online only.

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    Forest plots comparing serum CPK (A) and serum CRP (B) on postoperative day 1 between OM and ED. Figure is available in color online only.

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