Minimally invasive discectomy associated with higher recurrence rates

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The safety and efficacy of minimally invasive discectomy: a meta-analysis of prospective randomised controlled trialsIO

Int Orthop. 2014 Jun;38(6):1225-34. doi: 10.1007/s00264-014-2331-0. Epub 2014 Apr 11.
Chang X, Chen B, Li HY, Han XB, Zhou Y, Li CQ.

Department of Orthopedics, Xinqiao Hospital, The Third Military Medical University, Chongqing, 400037, People’s Republic of China

Therapuetic level of Evidence: Level 1

This meta analysis included 16 Randomised Control Trials comparing(MID: 1085 patients, SD: 1054 patients) minimally invasive discectomy (MID) to standard discectomy (SD) in the management of lumbar disc herniation, with respect to risk of recurrence, safety, and efficacy. Recently, there has been an increasing trend of using endoscopic discectomy(Minimally invasive Discectomy) to treat disc herniations

Materials:

  • PubMed, EMBASE, Web of Science, Cochrane Library and the Chinese Biological Medicine Database were searched comprehensively
  • Randomised Control Trials which compared MID Vs Standard Discectomy alone were picked  based on strict inclusion and exclusion criteria
  • 2 independent authors extracted and analysed data according to Cochrane Guidelines
  • RevMan 5.2.0 software was used to analyse the following data from the studies: The age of the patients, size of incision, surgical time, blood loss, visual analogue scale (VAS) score after the surgery, hospital stay, disc herniation recurrence, X-ray exposure and surgical costs in these studies

Results
• Recurrence rates with respect to disc herniation were higher in Minimally Invasive Discectomy compared to Standard Discectomy
(RR: 1.95[95% CI 1.19-3.19).
• No difference in postoperative VAS Leg Pain scores between MID vs. SD (WMD: -0.02, [95% CI =0.05 to 0.01)
• 4 studies analysed size of incision. MID was associated with significantly shorter incision length over SD, although with
significant heterogeneity (SMD: -19.1 [95% CI -3.33 to -0.50).
• Comparable complication rates between two groups out of 7 studies that were analysed RR: 0.95 [95% CI 0.69 to 1.30];
• Surgical time : Longer duration was seen with MID(MD: 9.61 [95% CI 7.63 to 11.60];).
• Blood loss: Significantly less blood loss was reported in MID
• Hospital stay: Longer hospital stay in SD(SMD: 0.17 days [95% CI -0.29 to -0.06;).
• X-ray exposure and surgical costs were not reported often

Conclusions:
• Total number of complications and Postoperative leg pain (visual analogue scale [VAS]) scores were similar between minimally
invasive discectomy (MID) and standard discectomy (SD).
• Incision size (significant heterogeneity), blood loss, and hospital stay (significant heterogeneity) favoured MID
• Disc herniation recurrence rates, surgical time favoured SD over MID when respective results were pooled.
• MID appears promising with smaller incisions, lesser surgical times and improved hospital stay with significant reduction in
morbidity; higher recurrence rates is still a matter of concern
Ref:
1. http://link.springer.com/article/10.1007%2Fs00264-014-2331-0

2. www.myorthoevidence.com

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