Complication rates of different discectomy techniques for the treatment of lumbar disc herniation: a network meta-analysis



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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.


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

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