Meta-analysis of the clinical effects and postoperative re-protrusion rate of limited resection and subtotal resection of lumbar intervertebral disc herniation

English Keywords:Lumbar disc herniation  Limited discectomy  Subtotal discectomy  Meta-analysis

English Abstract:

  【Abstract】 Objectives: To evaluate the clinical outcomes and postoperative reherniation rates of limited discectomy versus subtotal discectomy for lumbar disc herniation through a meta-analysis. Methods: A systematic search was conducted in the PubMed, Cochrane Library, Web of Science, Embase, China National Knowledge Infrastructure(CNKI), Wanfang, and VIP databases from their inception until August 2025 for controlled clinical trial studies about limited discectomy and subtotal discectomy in the treatment of lumbar disc herniation. Data of outcomes were extracted from the included studies, such as operative time, intraoperative blood loss, length of hospital stay, low back pain visual analogue scale(VAS) score, lower limb pain VAS score, disc reherniation rate, and complications. A meta-analysis was performed using RevMan 5.3 software. The Cochrane Risk of Bias tool was used to assess randomized controlled trials(RCT), while the Newcastle-Ottawa scale(NOS) was applied to evaluate retrospective and prospective studies. Results: A total of 14 English-language studies were included, comprising 3 RCTs, 5 prospective studies, and 6 retrospective studies. The quality of the included studies were all medium and high. The total sample size was 1,864 patients, with 857 patients in the limited discectomy group and 1,007 patients in the subtotal discectomy group. Meta-analysis results indicated: The operative time in the limited discectomy group was significantly shorter than that in the subtotal discectomy group[MD=-8.72, 95%CI(-15.76, -1.68), P=0.02]. At 1-year and 2-year follow-ups, the low back pain VAS score was significantly lower in the limited discectomy group compared with the subtotal discectomy group[1-year: MD=-0.30, 95%CI(-0.44, -0.17), P<0.0001; 2-year: MD=-0.25, 95%CI(-0.36, -0.14), P<0.00001]. At 2-year follow-up, the lower limb pain VAS score was significantly lower in the limited discectomy group compared with the subtotal discectomy group[MD=-0.20, 95%CI(-0.31, -0.09), P=0.0005]. No statistically significant difference was found between the two groups in the postoperative reherniation rate[OR=1.13, 95%CI (0.77, 1.67), P=0.53], incidence of postoperative complications[OR=0.82, 95%CI(0.59, 1.14), P=0.23], intraoperative blood loss[MD=10.10, 95%CI(-18.03, 38.22), P=0.48], or in the length of hospital stay[MD=-0.02, 95%CI(-0.12, 0.07), P=0.63]. Conclusions: The meta-analysis indicates that there is no significant difference in the risk of postoperative reherniation or complications between the two discectomy techniques for lumbar disc herniation. Patients undergoing limited discectomy experience slightly better outcomes in terms of low back and lower limb pain relief, as well as shorter operative time, which requires further validation through large-scale RCTs.