Clinical Efficacy and Safety of Percutaneous Spinal Endoscopy versus Traditional Open Surgery for Lumbar Disc Herniation: Systematic Review and Meta-Analysis

Abstract

Objective. Systematic analysis of the incidence of percutaneous spinal endoscopic technique and traditional open surgery for lumbar disc herniation. Methods. A randomized controlled trial (RCT) and cohort study on complications related to traditional open surgery was searched on the MEDLINE, Cochrane Library, PubMed, Web of Science, Chinese journal full-text database (CNKI), Wanfang, and Embase database. Language is not limited. The quality of each study was evaluated, various complications were compiled into electronic baseline tables, and the data from these studies were available. Meta-analysis and synthesis were performed with the RevMan 5.3 software to evaluate the statistical significance of both surgical techniques in terms of various complications. Results. 12 studies were eventually included, and a total of 2,797 patients were included in the analysis. Meta-analysis results showed that there was no statistical difference in postoperative paresthesia between percutaneous spinal endoscopy and traditional open surgery (OR = 1.17, 95% CI (0.82, 1.66), P = 0.38, I2 = 0%, Z = 0.88), direct nerve root damage (OR = 0.79, 95% CI (0.58, 1.07), P = 0.13, I2 = 73%, Z = 1.52), and intraoperative hemorrhage and hematoma formation (OR = 1.00, 95% CI (0.67, 1.48), P = 0.99, I2 = 0%, Z = 0.02), but there was a statistical difference in disc recurrence (OR = 2.24, 95% CI (1.56, 3.21), P < 0.0001, I2 = 81%, Z = 4.39). Conclusion. Compared with the traditional open surgical treatment of lumbar disc herniation, percutaneous spinal endoscopic technology has obvious advantages in reducing nerve root injury, dural injury, and surgical area wound complications, but it is limited to preventing the technical characteristics of the surgical site, which is worse than that of open surgery.

Efficacy of Transforaminal Endoscopic Lumbar Discectomy in Elderly Patients Over 65 Years of Age Compared to Young Adults

“…MISS techniques have rapidly improved over the past 2 decades, and one of the most advanced MISS techniques for patients with lumbar disc herniation is TELD [ 12 ]. TELD minimizes damage to surrounding structures and does not require general anesthesia [ 12 , 34 ]. Several authors have reported that TELD is superior to conventional surgery, including microscopic discectomy, in terms of outcomes and complication rates [ 34 , 35 ].…”

“…TELD minimizes damage to surrounding structures and does not require general anesthesia [ 12 , 34 ]. Several authors have reported that TELD is superior to conventional surgery, including microscopic discectomy, in terms of outcomes and complication rates [ 34 , 35 ]. Based on this concept, many authors have suggested that MISS might be more beneficial than conventional surgery in the elderly, and full endoscopic surgery could be applied safely in elderly patients [ 7 , 34 , 36 , 37 ].…”

Clinical efficacy of unilateral biportal endoscopy in the treatment of lumbar disc herniation

“…At the same time, the weakening of the muscle strength of the lumbar back may lead to the occurrence of lumbar instability. [20,21] To further improve the clinical effect of surgery, spine surgery has entered the era of minimally invasive surgery under the continuous research of spine surgeons.…”

Early efficacy of postoperative rehabilitation training for lumbar disc herniation

“…However, due to the need to peel off the paravertebral muscle in spinal surgery, the distal nerve of the muscle is innervated, which may lead to intractable back pain after surgery. At the same time, the weakening of the muscles in the lower back will cause instability in the lumbar spine [ 12 , 13 ].…”