Minimally invasive versus open surgery for cervical and lumbar discectomy: a systematic review and meta-analysis

Evaniew, Nathan; Khan, Moin; Drew, Brian; Kwok, Desmond; Bhandari, Mohit; Ghert, Michelle

doi:10.9778/cmajo.20140048

Cited by 31 publications

(49 citation statements)

References 80 publications

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“…In line with this trend, operative techniques, surgical devices, and intraoperative monitoring equipment have improved and have resulted in reduced peri‐procedural complication rates. Minimally invasive spinal surgery (MIS) is gaining more relevance, especially because the surgical tissue trauma is significantly reduced when compared to open surgical procedures. MIS performed by experienced surgeons have shown improved clinical outcomes and lower perioperative morbidities (e.g.…”

Section: Introductionmentioning

confidence: 99%

Surgical and Clinical Results of Minimally Invasive Spinal Fusion Surgery in an Unselected Patient Cohort of a Spinal Care Unit

Senker

Gruber

Gmeiner

et al. 2018

Orthopaedic Surgery

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Section: Introductionmentioning

confidence: 99%

Surgical and Clinical Results of Minimally Invasive Spinal Fusion Surgery in an Unselected Patient Cohort of a Spinal Care Unit

Senker

Gruber

Gmeiner

et al. 2018

Orthopaedic Surgery

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“…The optimal patient is one with predominant unilateral leg pain, extending below the knee that has been present for atleast 6 weeks despite conservative measures. The operated patients had less postoperative pain due to the minimal soft tissue exposure, minimal handling of paraspinal muscles on one side only, less or no damage to lamina, no damage to facet joints [12,13,14] . All the patients required less dose of postoperative analgesics.…”

Section: Resultsmentioning

confidence: 99%

A prospective analysis of efficacy of fenestration discectomy in patients with symptomatic lumbar disc prolapse

Rajavel¹,

J²

2017

Int. J. Orthop. Sci.

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Background: Aim of the study was to evaluate the efficacy of Fenestration Discectomy in symptomatic Lumbar Disc Prolapse in terms of pain relief, recovery of neurological deficit and assessing complication rates. Material and Method: 20 cases of symptomatic lumbar disc prolapse, not responding to conservative measures for 6 weeks were treated with fenestration discectomy and followed for a period of 2 and a half years from June 2014 to dec 2016. Result: Out of 20 cases, overall results include best result in 16, good in 2, fair in 1 and poor in 1.Spinal movements improved in 16 cases, worsened in 1 and remained same in 3 cases. SLR improved in 19 cases and remained same in 1 case. Out of 8 patients with neurological deficit, 6 recovered and 2 remained the same. Complications like dural tear occurred in 2 cases, EHL weakness occurred in 1 case and infection occurred in 1 case. Conclusion: 80 % of cases had best results, 10% had good results, 5% fair result and 5% poor result. Success of surgery depends on selection of patients, correct identification of level intra operatively and avoiding complications.

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“…Minimally important differences (MIDs) are the smallest effects that a patient would consider beneficial to justify a procedure 41 and have been studied for multiple different scales within the field of spinal surgery. The MID for the VAS is found to be 2.5 points for extremity, 42 and 3.5 points for VAS axial pain.…”

Section: Discussionmentioning

confidence: 99%

The Role of Anterior Cervical Discectomy and Fusion on Relieving Axial Neck Pain in Patients With Single-Level Disease: A Systematic Review and Meta-Analysis

Oitment

Watson

Lam

et al. 2019

Global Spine Journal

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Study Design: Systematic review and meta-analysis. Objectives: This study aims to evaluate the effects of anterior cervical decompression and fusion (ACDF) on axial neck pain in adult patients receiving surgery for myelopathy, radiculopathy, or a combination of both. Methods: Two independent reviewers completed a librarian-assisted search of 4 databases. Visual Analogue Scale (VAS) and Neck Disability Index (NDI) scores were extracted preoperatively and at 3, 6, 12, 24, 36, 48, and 48+ months postoperatively for ACDF groups and pooled using a random-effects model. Results: Of 17 850 eligible studies, 37 were included for analysis, totaling 2138 patients analyzed with VAS and 2477 with NDI score. Individual VAS mean differences were reduced at 6 weeks (−2.5 [95% confidence interval (CI): −3.5 to −1.6]), 3 months (−2.9 [−3.7 to −2.2]), 6 months (−3.2 [−3.9 to −2.6]), 12 months (−3.7 [−4.3 to −3.1]), 24 months (−4.0 [−4.4 to −3.5]), 48 months (−4.6 [−5.5 to −3.8]), and >48 months (−4.7 [−5.8 to −3.6]) follow-up ( P < .0001 for all endpoints). Individual NDI mean differences were reduced at 6 weeks (−26.7 [−30.9 to −22.6]), 3 months (−29.8 [−32.7 to −26.8]), 6 months (−31.2 [−35.5 to −26.8)], 12 months (−29.3 [−33.2 to −25.4]), 24 months (−28.9 [−32.6 to −25.2]), 48 months (−33.1 [−37.4 to −28.7]), and >48 months (−37.6 [−45.9 to −29.3]) follow-up ( P < .0001 for all endpoints). Conclusions: ACDF is associated with a significant reduction in axial neck pain compared with preoperative values in patients being treated specifically for myelopathy or radiculopathy. This influences the preoperative discussions surgeons may have with patients regarding their expectations for surgery. The effects seen are stable over time and represent a clinically significant reduction in axial neck pain.

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Minimally invasive versus open surgery for cervical and lumbar discectomy: a systematic review and meta-analysis

Abstract: Current evidence does not support the routine use of minimally invasive surgery for cervical or lumbar discectomy. Well-designed trials are needed given the lack of high-quality evidence.

Cited by 31 publications

References 80 publications

Surgical and Clinical Results of Minimally Invasive Spinal Fusion Surgery in an Unselected Patient Cohort of a Spinal Care Unit

Surgical and Clinical Results of Minimally Invasive Spinal Fusion Surgery in an Unselected Patient Cohort of a Spinal Care Unit

A prospective analysis of efficacy of fenestration discectomy in patients with symptomatic lumbar disc prolapse

The Role of Anterior Cervical Discectomy and Fusion on Relieving Axial Neck Pain in Patients With Single-Level Disease: A Systematic Review and Meta-Analysis

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