A SYSTEMATIC REVIEW ON THE OUTCOMES OF ENDOSCOPIC DISCECTOMY AND MINIMAL INVASIVE DISCECTOMY COMPARED TO CONVENTIONAL MICRODISCECTOMY
Conference: Eurospine Meeting 2018At: Barcelona
A SYSTEMATIC REVIEW ON THE OUTCOMES OF ENDOSCOPIC DISCECTOMY AND MINIMAL INVASIVE DISCECTOMY COMPARED TO CONVENTIONAL MICRODISCECTOMY
Purpose: The aim of this study was to compare the safety and effi- cacy of minimally invasive techniques for the treatment of Lumbar Disc Herniation (LDH) using Percutaneous Endoscopic Discectomy (PED) and Minimal Invasive Discectomy with tubular retractors (MID) versus conventional microdiscectomy (MD) which is consid- ered the ‘‘gold standard surgical treatment’’ for LDH. Methods: The systematic review was conducted using the Preferred Reporting Items for systematic Reviews and MetaAnalysis (PRISMA). Literature search was performed using data from PubMed, Google scholar and Google for studies performed up to December 2017. The quality assessment and clinical relevance cri- teria used were the Cochrane Musculoskeletal Review Group criteria as utilized for randomised trials. The inclusion criteria were that the studies needed to be randomised controlled trials comparing, the patients needed to have discectomy with one of the above methods due to LDH at one lumbar level, follow up of more than 12 months, monitor the Visual Analog Scale (VAS) for the affected leg and back pain, Oswestry Disability Index (ODI) or Roland-Morris Disability Score as outcome scores. Exclusion criteria were studies with less than 12 months of follow up and studies that did not describe accu- rately the surgical method used. Results: The data of nine randomised controlled trials (RCT) which met the inclusion criteria were analysed with a total number of 1475 patients included. 4 RCT’s compared the results of MID to MD and 5RCT’s compared the results of PED to MD. No statistically signif- icant difference was found in the VAS for back pain when comparing PEDandMIDtoMD(WMD0.04,P = 0.92andWMD0,09P = 0.18 respectively) at 1 year follow up. Also no significant difference was found in the ODI for PED and MID compared to MD (P = 0.34 and P = 0.21 respectively.) PED demonstrated statistically significant lower estimated blood loss when compared to MD (P \ 0.05). No significant difference in overall complication and reoperation rate was found between PED and MD and MID compared to MD. Conclusion: Based on this systematic review PED and MID are both as effective and safe as standard MD. Keywords: endoscopic discectomy versus microdiscectomy, minimally invasive discectomy versus microdiscectomy, tubular discectomy.
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Source: researchgate.net