A network meta-analysis of different surgical methods in the treatment of lumbar disc herniation / 中国组织工程研究

ABSTRACT

BACKGROUND: At present, there are many surgical methods for the treatment of lumbar disc herniation, and the therapeutic effects have their own advantages. Although there are many meta-analyses to compare the therapeutic effects of the two surgical methods, there is no comparison of the therapeutic effects of several surgical methods. OBJECTIVE: To compare the differences of different surgical methods in the treatment of lumbar disc herniation by network meta-analysis. METHODS: PubMed, Embase, Cochrane Library, Ovid and CNKI were searched, and randomized controlled trials or retrospective studies on different surgical methods for the treatment of lumbar disc herniation were collected. According to the inclusion and exclusion criteria established in advance, the quality of included randomized controlled trials was evaluated, and the data were analyzed by STATA 15.0 software. RESULTS AND CONCLUSION: A total of 42 studies, 5 156 patients and 9 surgical treatments were included. Surgical treatments contain total disc replacement, lumbar disc fusion, standard open discectomy, microendoscopic discectomy, microdiscectomy, percutaneous endoscopic lumbar discectomy, chemonucleolysis, automatic percutaneous lumbar discectomy and percutaneous laser disc decompression. The results of network meta-analysis showed that(from best to worst)(1) There was no significant difference in leg pain relief, and the rank probability was percutaneous laser disc decompression > microendoscopic discectomy > percutaneous endoscopic lumbar discectomy > standard open discectomy > microdiscectomy > lumbar disc fusion > total disc replacement.(2) There was no significant difference in low back pain relief, and the rank probability was total disc replacement > lumbar disc fusion > microendoscopic discectomy > percutaneous endoscopic lumbar discectomy > microdiscectomy > percutaneous laser disc decompression > standard open discectomy.(3) There was no significant difference in Oswestry disability index scores, and the rank probability was microendoscopic discectomy > percutaneous endoscopic lumbar discectomy > standard open discectomy > microdiscectomy > total disc replacement > lumbar disc fusion.(4) There were some statistical differences in the success rate, and the rank probability was total disc replacement > lumbar disc fusion > microendoscopic discectomy > percutaneous endoscopic lumbar discectomy > standard open discectomy > percutaneous laser disc decompression > microdiscectomy > chemonucleolysis > automatic percutaneous lumbar discectomy.(5) There was no significant difference in reoperation rate, and the rank probability was total disc replacement > lumbar disc fusion > microdiscectomy > microendoscopic discectomy > standard open discectomy > percutaneous endoscopic lumbar discectomy > percutaneous laser disc decompression > chemonucleolysis > automatic percutaneous lumbar discectomy.(6) There were some statistical differences in incidence of complications, and the rank probability was percutaneous endoscopic lumbar discectomy > automatic percutaneous lumbar discectomy > standard open discectomy > microdiscectomy > percutaneous laser disc decompression > microendoscopic discectomy > total disc replacement > lumbar disc fusion > chemonucleolysis. Results suggested that microendoscopic discectomy and percutaneous endoscopic lumbar discectomy are effective in all aspects. Disc replacement and lumbar disc fusion are the best in success rate of operation. Chemonucleolysis is poor in success rate of operation, reoperation rate and complications rate. Percutaneous automatic discectomy is poor in success rate of operation and reoperation rate.