Complication rates of different discectomy techniques for the treatment of lumbar disc herniation: a network meta-analysis
RIS ID
139082
Abstract
Purpose: The aim of this network meta-analysis (NMA) was to compare the complication rates of discectomy/microdiscectomy, percutaneous laser disc decompression (PLDD), percutaneous endoscopic lumbar discectomy (PELD), microendoscopic discectomy (MED), and tubular discectomy for symptomatic lumbar disc herniation (LDH). Methods: We searched three online databases for randomized controlled trials (RCTs). Overall complication rates, complication rates per general and modifed Clavien-Dindo classifcation schemes, and reoperation rates were considered as primary outcomes. Odds ratio with 95% confdence intervals for direct comparisons and 95% credible intervals for NMA results were reported. Surface under cumulative ranking curve (SUCRA) was used to estimate ranks for each discectomy technique based on the complication rates. Results: In total, 18 RCTs with 2273 patients were included in this study. Our results showed that there was no significant diference in any of the pairwise comparisons. PELD (SUCRA: 0.856) ranked the lowest for overall complication rates. Discectomy/microdiscectomy (SUCRA: 0.599) and PELD (SUCRA: 0.939) ranked the lowest for intraoperative and postoperative complication rates, respectively. Concerning modifed Clavien-Dindo classifcation scheme, PELD (SUCRA: 0.803), MED (SUCRA: 0.730), and PLDD (SUCRA: 0.605) ranked the lowest for the occurrence of type I, II, and III complications, respectively. Tubular discectomy (SUCRA: 0.699) ranked the lowest for reoperation rates. Conclusions: The results of this NMA suggest that discectomy/microdiscectomy and PELD are the safest procedures for LDH with minimal intraoperative and post-operative complications, respectively. PELD, MED, and PLDD are the safest procedures for LDH in terms of minimal rates for complications necessitating conservative, pharmacological, and surgical treatment, respectively
Publication Details
Chen, X., Chamoli, U., Lapkin, S., Vargas Castillo, J. & Diwan, A. D. (2019). Complication rates of different discectomy techniques for the treatment of lumbar disc herniation: a network meta-analysis. European Spine Journal, 28 (11), 2588-2601.