Percutaneous spinal endoscopy vs traditional open surgery: systematic evaluation and Meta-analysis of operative complication in lumbar disc herniation

English Keywords:Spinal endoscopy  Lumbar disc herniation  Complication  Meta analysis

English Abstract:

  【Abstract】 Objectives: To systematically analyze the incidence and characteristics of complications for percutaneous spinal endoscopy and conventional open surgery in lumbar disc herniation. Methods: Randomized controlled trails and cohort studies were searched independently by two authors in MEDLINE, Cochrane library, Pubmed database, Web of Science, China Knowledge Network, Wanfang and Embase databases on percutaneous spinal endoscopy and traditional open surgery for lumbar disc herniation. There was no limit to the language. The authors independently assessed the quality of each study, extracted the intraoperative and postoperative complications(postoperative paresthesia, direct nerve root injury, dural injury, surgical site wound complications, intervertebral disc recurrence, residual nucleus pulposus, additional surgery for associated complications and other complications) in each study into an electronic baseline table and analyzed the data through Revman 5.3 software for meta-analysis and synthesis. Various complications were evaluated between the two surgical techniques. Results: A total of 24 studies were eventually included, and a total of 2797 patients was included in the analysis. Comparing percutaneous spinal endoscopy and conventional open surgery, the incidence of postoperative sensory abnormalities[OR=0.84, 95% CI(0.57, 1.24)] was essentially the same. The incidence of additional surgery related to complication[OR=1.15, 95% CI(0.79, 1.66)] was slightly higher, but there was no significant difference(P>0.05). The incidence of intervertebral disc recurrence[OR=1.03, 95% CI(0.67, 1.61)] and other complications[OR=0.88, 95% CI(0.53, 1.46)] in the latter was slightly higher than the former, but there was no significant difference(P>0.05). The incidence of nucleus pulposus residue in the former[OR=2.82, 95% CI(1.36, 5.85)] was higher, the difference was significant(P<0.05). The incidences of nerve root injury[OR=0.28, 95% CI(0.09, 0.80)], dural injury[OR=0.34, 95% CI(0.17, 0.70)], wound complication in operation area[OR=0.31, 95% CI(0.14, 0.70)] in the latter were higher, the differences were significant(P<0.05). Conclusions: Compared with traditional open surgery for lumbar disc herniation, percutaneous spinal endoscopy has a significant advantage in reducing nerve root injury, dura mater injury and wound complications in the operation area, but is limited in preventing residual nucleus pulposus at the surgical site. The characteristics of percutaneous endoscopy are worse than open surgery.