医学
经皮
外科
椎间盘切除术
Oswestry残疾指数
椎间盘移位
可视模拟标度
腰椎间盘突出症
科克伦图书馆
椎间盘切除术
回顾性队列研究
腰痛
减压
背痛
作者
Pravesh S. Gadjradj,Biswadjiet S. Harhangi,Jantijn Amelink,Job L C van Susante,Steven J. Kamper,Maurits W. van Tulder,Wilco C. Peul,Carmen L.A.M. Vleggeert-Lankamp,Sidney M. Rubinstein
出处
期刊:Spine
[Ovid Technologies (Wolters Kluwer)]
日期:2021-04-15
卷期号:46 (8): 538-549
被引量:16
标识
DOI:10.1097/brs.0000000000003843
摘要
Study Design. Systematic review and meta-analysis. Objective. To give a systematic overview of effectiveness of percutaneous transforaminal endoscopic discectomy (PTED) compared with open microdiscectomy (OM) in the treatment of lumbar disk herniation (LDH). Summary of Background Data. The current standard procedure for the treatment of sciatica caused by LDH, is OM. PTED is an alternative surgical technique which is thought to be less invasive. It is unclear if PTED has comparable outcomes compared with OM. Methods. Multiple online databases were systematically searched up to April 2020 for randomized controlled trials and prospective studies comparing PTED with OM for LDH. Primary outcomes were leg pain and functional status. Pooled effect estimates were calculated for the primary outcomes only and presented as standard mean differences (SMD) with their 95% confidence intervals (CI) at short (1-day postoperative), intermediate (3-6 months), and long-term (12 months). Results. We identified 2276 citations, of which eventually 14 studies were included. There was substantial heterogeneity in effects on leg pain at short term. There is moderate quality evidence suggesting no difference in leg pain at intermediate (SMD 0.05, 95% CI -0.10-0.21) and long-term follow-up (SMD 0.11, 95% CI -0.30-0.53). Only one study measured functional status at short-term and reported no differences. There is moderate quality evidence suggesting no difference in functional status at intermediate (SMD -0.09, 95% CI -0.24-0.07) and long-term (SMD -0.11, 95% CI -0.45-0.24). Conclusion. There is moderate quality evidence suggesting no difference in leg pain or functional status at intermediate and long-term follow-up between PTED and OM in the treatment of LDH. High quality, robust studies reporting on clinical outcomes and cost-effectiveness on the long term are lacking.
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