ABSTRACT
BACKGROUND: With the rapid development of intervertebral disc interventional technology, surgical treatment of lumbar disc herniation has made great progress, but at the same time, surgeons and patients have more choices. Therefore, it is particularly important to compare the efficacy and safety of new surgical methods and traditional widely accepted treatment methods. Traditional meta-analysis cannot classify the advantages and disadvantages of various surgical methods. OBJECTIVE: To evaluate the efficacy and safety of seven surgical interventions for the treatment of lumbar disc herniation using network meta-analysis. METHODS: We performed a Bayesian-framework network meta-analysis of randomized controlled trials to compare seven surgical interventions for people with lumbar disc herniation, including percutaneous endoscopic lumbar discectomy, standard open discectomy, standard open microsurgical discectomy, chemonucleolysis, microendoscopic discectomy, percutaneous laser disc decompression, and automated percutaneous lumbar discectomy. The eligible randomized controlled trials were identified by searching the Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, Embase and Google scholar. Data from three outcomes (success rate, complication rate, and reoperation rate) were independently extracted by two assessors. RESULTS AND CONCLUSION: (1) A total of 29 randomized controlled trials (31 literatures) including 3 146 participants were finally included into this article. (2) Our Meta-analysis provides hierarchies of these seven interventions. For the success rate, the rank probability is as follows (from best to worst): Percutaneous endoscopic lumbar discectomy > standard open discectomy > standard open microsurgical discectomy > chemonucleolysis > microendoscopic discectomy > percutaneous laser disc decompression > automated percutaneous lumbar discectomy. (3) For the complication rate, the rank probability is as follows (from best to worst): Percutaneous endoscopic lumbar discectomy > standard open microsurgical discectomy > standard open discectomy > microendoscopic discectomy > percutaneous laser disc decompression > chemonucleolysis > automated percutaneous lumbar discectomy. (4) For the reoperation rate, the rank probability is as follows (from best to worst): Standard open microsurgical discectomy > standard open discectomy > microendoscopic discectomy > percutaneous laser disc decompression > percutaneous endoscopic lumbar discectomy > chemonucleolysis > automated percutaneous lumber discectomy. (5) This meta-analysis provides evidence that percutaneous endoscopic lumbar discectomy might be the best choice to increase the success rate and decrease the complication rate. Moreover, standard open microsurgical discectomy might be the best option to drop the reoperation rate. Automated percutaneous lumbar discectomy might lead to the lowest success rate and the highest complication rate. It is hoped that one-to-one randomized controlled trials of high quality will further validate the results of this study.
ABSTRACT
@#AIM: To compare effects of combined glaucoma-cataract surgery on pseudoexfoliation glaucoma(PXG)and primary open angle glaucoma(POAG).<p>METHODS: This was a retrospective case-control study conducted the hospitalized patients at department of glaucoma from January 2015 to January 2018. The PXG group included 40 eyes of 38 cases, with 46 eyes of 36 cases on POAG group, which were matched for baseline data. Visual acuity, intraocular pressure(IOP), number of anti-glaucoma medications used and occurrence of complications were observed in both groups after trabeculectomy + phacoemulsification + IOL implantation. Surgical success was defined according to the following 2 criteria: criterion A: IOP≤21mmHg, criterion B: IOP≤18mmHg. Complete success, and qualified success is defined as patients met these criteria with medical treatment(≤3 medications). <p>RESULTS: The visual acuity was improved, with IOP and the number of anti-glaucoma medications used both reduced in both group after surgery. There was no statistically significant difference in complete and qualified success rates between the two groups at 1 and 3mo after surgery(<i>P</i>>0.05). Postoperative 6mo, 1 and 2a, for criterion A: the qualified success rates in PXG group(90%, 80%, 74%)were slightly lower than that of POAG group(91%, 86%, 82%, <i>P</i>>0.05). The complete success rates in PXG group(50%, 40%, 29%)were significantly lower than that of POAG group(85%, 64%, 61%, <i>P</i><0.05). For criterion B: the qualified success rates in PXG group(70%, 70%, 59%)were slightly lower than that of POAG group(80%, 80%, 75%, <i>P</i>>0.05). The complete success rates in PXG group(45%, 30%, 18%)were significantly lower than that of POAG group(78%, 61%, 54%, <i>P</i><0.05).<p>CONCLUSION: The combined glaucoma-cataract surgery in PXG and POAG patients can significantly improve visual acuity and reduce intraocular pressure. The short-term success rates of both types of glaucoma were similar, however the long-term success rates of PXG patients was significantly lower, and it was difficult to achieve a low level IOP.