Comparative Clinical Effectiveness of Tubular Microdiscectomy and Conventional Microdiscectomy for Lumbar Disc Herniation

Abstract

Study Design. This study is a systematic literature review and meta-analysis. Objective. To evaluate the efficacy of tubular microdiscectomy (TMD) compared with conventional microdiscectomy (CMD) for lumbar disc herniation (LDH). Summary of Background Data. TMD has developed rapidly due to reduced tissue trauma by minimization of the required access to spine and disc herniation; however, CMD remains the standard of care for this patient group. To date, it remains debatable whether TMD is superior to CMD for LDH. Methods. We performed a comprehensive database search of PubMed, EMBASE, and Cochrane Central Register of Controlled Trails for prospective randomized controlled trials (RCTs), through using Medical Subject Headings (MeSH) terms “microdiscectomy,” “tubular microdiscectomy,” “minimally invasive surgery,” and “spinal disease.” The retrieved results were last updated on March 15, 2018. Two independent investigators selected qualified studies, extracted indispensable data, assessed risk of bias of original papers. The Grades of Recommendation, Assessment, Development and Evaluation (GRADE) approach was used to grade quality of evidence. If I 2 >50, the heterogeneity is considerable. Results. Four RCT studies (total n = 605), involving 610 individuals with a follow-up period of no less than 12 months, were selected for further review. We assessed these studies as low overall risk of bias. There was low-quality evidence that TMD was superior to CMD considering postoperative Oswestry Disability Index scores (SMD, –3.43, 95% CI, –4.64 to –2.21, P < 0.00001). Compared with CMD, the TMD group exhibited significantly worse Short Form-36 physical function scores (SMD, –4.83, 95% CI, –8.94 to –0.72, P = 0.02). There were no significant differences in the visual analogue scale (P = 0.30), operative time (P = 0.68), dural tear (P = 0.52), and reoperation (P = 0.98). Conclusion. The benefits 1 year after TMD were similar to that of CMD. There was no significant difference in the incidence of reoperation and dural tear. Level of Evidence: 1

Clinical evaluation of percutaneous transforaminal endoscopic discectomy (PTED) and paraspinal minitubular microdiscectomy (PMTM) for lumbar disc herniation: study protocol for a randomised controlled trial

“…In 2002, Greiner-Perth R et al 11 demonstrated that the use of tubular retractors and trocar systems combined with microscopy could overcome the disadvantage of the two dimensionality of the endoscopic image obtained during traditional CMD. Since then, the results of multiple randomised controlled trials (RCTs) and systematic reviews12–15 comparing the efficacy of tubular microdiscectomy (TMD) and CMD have revealed no significant difference between the two. Recently, Zhuang et al and Chunmei et al 16 17 improved on the tubular retractors and trocar systems and introduced the paraspinal minitubular microdiscectomy system (PMTM).…”

Reoperation Rates of Microendoscopic Discectomy Compared With Conventional Open Lumbar Discectomy: A Large-database Study

“…A few studies have demonstrated that microendoscopic discectomy was associated with comparable pain relief and lower risk of systemic complications and shorter hospital stay than microdiscectomy or open discectomy [21,30]. However, previous studies examining the risk of reoperation after microendoscopic discectomy compared with microdiscectomy or open discectomy have yielded inconsistent findings [24,30]. In this large, claims-based database study comparing reoperation rates for patients receiving microendoscopic discectomy or microdiscectomy or open discectomy, we found that microendoscopic discectomy was associated with a higher reoperation risk than microdiscectomy or open discectomy at a median of 4 years postoperatively.…”

“…Although several studies have compared microendoscopic discectomy with microdiscectomy or open discectomy with regard to clinical outcomes and perioperative complications [10, 24, 30], very few studies have compared long-term reoperation rates between microendoscopic discectomy and microdiscectomy or open discectomy. Unlike one of these previous studies [10], our data showed that microendoscopic discectomy had a higher reoperation risk at a median of 4 years of follow-up than microdiscectomy or open discectomy.…”

Clinical comparison of percutaneous transforaminal endoscopic discectomy and unilateral biportal endoscopic discectomy for single-level lumbar disc herniation

“…With advances in medical technology, open discectomy has been gradually replaced by minimally invasive spine surgery, and microdiscectomy has become an important part of the treatment of LDH ( 4 ). Facilitated by the development of endoscopic equipment and techniques, a variety of modified minimally invasive lumbar surgical techniques have been developed ( 5 ).…”