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Complication rates of different discectomy techniques for symptomatic lumbar disc herniation: a systematic review and meta-analysis

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Abstract

Purpose

This meta-analysis aims to compare the complication rates of discectomy/microdiscectomy (OD/MD), microendoscopic discectomy (MED), percutaneous endoscopic lumbar discectomy (PELD), percutaneous laser disc decompression (PLDD), and tubular discectomy for symptomatic lumbar disc herniation (LDH) using general classification and modified Clavien–Dindo classification (MCDC) schemes.

Methods

We searched three online databases for randomized controlled trials (RCTs) and cohort studies. Overall complication rates and complication rates per the above-mentioned classification schemes were considered as primary outcomes. Risk ratio (RR) and their 95% confidence intervals (CI) were evaluated.

Results

Seventeen RCTs and 20 cohort studies met the eligibility criteria. RCTs reporting OD/MD, MED, PELD, PLDD, and tubular discectomies had overall complication rates of 16.8% and 16.1%, 21.2%, 5.8%, 8.4%, and 25.8%, respectively. Compared with the OD/MD, there was moderate-quality evidence suggesting that PELD had a lower risk of overall complications (RR = 0.52, 95% CI 0.29–0.91) and high-quality evidence suggesting a lower risk of Type I complications per MCDC (RR = 0.37, 95% CI 0.16–0.81). Compared with the OD/MD data from cohort studies, there was low-quality evidence suggesting a higher risk of Type III complications per MCDC (RR = 10.83, 95% CI 1.29–91.18) for MED, higher risk of reherniations (RR = 1.67,95% CI 1.05–2.64) and reoperations (RR = 1.75, 95% CI 1.20–2.55) for PELD, lower risk of overall complication rates (RR = 0.42, 95% CI 0.25–0.70), post-operative complication rates (RR = 0.42, 95% CI 0.25–0.70), Type III complications per MCDC (RR = 0.39, 95% CI 0.22–0.69), reherniations (RR = 0.56, 95% CI 0.33–0.97) and reoperations (RR = 0.39, 95% CI 0.22–0.69) for PLDD.

Conclusions

Compared with the OD/MD, results of this meta-analysis suggest that PELD has a lower risk of overall complications and a lower risk of complications necessitating conservative treatment.

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Acknowledgements

The authors would like to thank Mark Donoghoe (Stats Central, UNSW) for his help with developing the database search strategy.

Funding

This work was supported by a Research Training Program scholarship and a University Postgraduate Award from the Australian Government and UNSW to XLC and a Scientia scholarship from UNSW to VASR. A Clinical Travelling Fellowship from the International Society for the Study of the Lumbar Spine (ISSLS) in 2018 further supported this work. JLVC was funded by an unrestricted educational and research donation by Nuvasive Australia.

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Authors and Affiliations

  1. Spine Labs, Level 3, WR Pitney Building, St. George and Sutherland Clinical School, University of New South Wales, Kogarah, NSW, 2217, Australia

    Xiaolong Chen, Uphar Chamoli, Vivek A. S. Ramakrishna & Ashish D. Diwan

  2. School of Biomedical Engineering, Faculty of Engineering and Information Technology, University of Technology Sydney, Ultimo, NSW, Australia

    Uphar Chamoli

  3. Spine Service, Department of Orthopaedic Surgery St. George Hospital Campus, Kogarah, NSW, Australia

    Jose Vargas Castillo & Ashish D. Diwan

  4. School of Mechanical and Manufacturing Engineering, University of New South Wales, Kensington, NSW, Australia

    Vivek A. S. Ramakrishna

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Chen, X., Chamoli, U., Vargas Castillo, J. et al. Complication rates of different discectomy techniques for symptomatic lumbar disc herniation: a systematic review and meta-analysis. Eur Spine J 29, 1752–1770 (2020). https://doi.org/10.1007/s00586-020-06389-5

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