Meta-analysis of the operative treatment of lumbar disc herniation via transforaminal percutaneous endoscopic discectomy versus interlaminar percutaneous endoscopic discectomy in randomized trials

摘要

Lumbar disc herniation (LDH) isacommon degenerative diseasethat predominantly occurs in thelower back between thefourth and fifth lumbar vertebral bodies (L4/L5) or between thefifth and thesacrum(L5/S1). In addition to lowback pain, symptomscan affect thesciatic nerve, resulting in radicular sciatica. [1] Althoughminorcases werereported to healwith non-surgicalintervention, in somecircumstances, surgeries were demanded forcorrection. [2] Open lumbar discectomywasapplied into the management oflumbar disc herniation. Nonetheless, thelong incision length scarring produced in the processes makes revision surgery challenging to locate. Percutaneousendoscopiclumbar discectomy (PELD),asa minimally invasivespinaltechnique,avoids the problemsand becomean alternativeto conventionalmean difference(MD). [3] Currently, thereare 2 operativeapproaches for PELD, that is, thetransforaminal(TF)approach described byKambin [3]and theinterlaminar (IL)approach described byRuetten. [4] According to accumulativestudies, IL-PELDwas mainly applied inL5/S1 level herniation surgeries,although in some other studies, IL-PELDwas reported to successfully correct herniation at other lumbar levels. TF-PELDwas originally regarded as notsuitablefor L5/S1 level. However, it was reported to beimproved to accessalllumbar levels,evenL5/S1. [5,6] Apractical problemforclinicians is lack ofstandard for decision oftheendoscopicroute,especially regarding the L5/S1 level. Judgementsabout the operationscommonly include operating time, X-ray exposure during the operation and postoperation outcomeevaluations. [7,8] Therefore, this study aimed to providescientificreferencefor the operation route options viacomparing the operation duration, X-ray exposureas wellas outcomes ofTF-PELDand IL-PELDto LDHpatientsas indicated by the published randomized clinicaltrials.