Efficacy and safety of PELD for L5/S1 disc herniation via transforaminal approach <i>versus</i> interlaminar approach: a meta-analysis _Chinese Journal of Evidence-Based Medicine

Authors：

ZHANG Tengfei , WU Wenkai ,  DENG Zhongliang , YAN Zhengjian , CHEN Liang

Department of Orthopedics, the Second Affiliated Hospital, Chongqing Medical University, Chongqing, 400010, P.R.China;

Corresponding author：

DENG Zhongliang, Email: zhongliang.deng@qq.com

Keywords：

Lumbar vertebrae; Intervertebral disc herniation; Percutaneous endoscopic lumbar discectomy; Transforaminal approach; Interlaminar approach; Meta-analysis; Systematic review; Randomized controlled trial; Cohort study

DOI：

10.7507/1672-2531.201710105

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

ObjectiveTo systematically review the efficacy and safety of percutaneous endoscopic lumbar discectomy (PELD) for L5/S1 disc herniation via transforaminal approach (TF-PELD) versus interlaminar approach (IL-PELD).MethodsPubMed, EMbase, The Cochrane Library, CBM, CNKI and WanFang Data databases were electronically searched to collect randomized controlled trials (RCTs) and the cohort studies of TF-PELD versus IL-PELD for L5/S1 disc herniation from inception to October 2017. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies, then, meta-analysis was performed by using RevMan 5.3 software.ResultsA total of 1 RCT and 7 cohort studies involving 414 patients were included. The results of meta-analysis indicated that: compared with IL-PELD group, TF-PELD group had longer operative time (MD=17.42, 95%CI 12.86 to 21.97, P<0.000 01) and more frequency of intraoperative fluoroscopy (MD=8.42, 95%CI 6.18 to 10.65,P<0.000 01), respectively. However, there were no significant differences between two groups in the post-operative visual analogue scale (MD=0.01, 95%CI –0.23 to 0.25,P=0.94), the post-operative Oswestry disability index (MD=–0.46, 95%CI –2.42 to 1.49, P=0.64), the excellent and good outcomes rate (RR=1.00, 95%CI 0.89 to 1.12, P=0.96), and the rate of complications (RR=0.73, 95%CI 0.45 to 1.18, P=0.20).ConclusionCurrent evidence shows that TF-PELD and IL-PELD are equally effective and safe for L5/S1 disc herniation, but IL-PELD is superior to TF-PELD in less operative time and less radiation exposure. Due to limited quality and quantity of the included studies, more high quality studies are needed to verify above conclusion.

Citation： ZHANG Tengfei, WU Wenkai, DENG Zhongliang, YAN Zhengjian, CHEN Liang. Efficacy and safety of PELD for L5/S1 disc herniation via transforaminal approach versus interlaminar approach: a meta-analysis . Chinese Journal of Evidence-Based Medicine, 2018, 18(4): 340-346. doi: 10.7507/1672-2531.201710105 Copy

1.	Yeung AT, Tsou PM. Posterolateral endoscopic excision for lumbar disc herniation: surgical technique, outcome, and complications in 307 consecutive cases. Spine, 2002, 27(7): 722-731.
2.	Yeung AT. Minimally invasive disc surgery with the Yeung Endoscopic Spine System (YESS). Surg Technol Int, 1999, 8: 267-277.
3.	Hoogland T, Schubert M, Miklitz B, et al. Transforaminal posterolateral endoscopic discectomy with or without the combination of a low-dose chymopapain: a prospective randomized study in 280 consecutive cases. Spine, 2006, 31(24): E890-E897.
4.	Ruetten S, Komp M, Godolias G. A new full-endoscopic technique for the interlaminar operation of lumbar disc herniations using 6-mm endoscopes: prospective 2-year results of 331 patients. Minim Invasive Neurosurg, 2006, 49(2): 80-87.
5.	Choi G, Lee SH, Raiturker PP, et al. Percutaneous endoscopic interlaminar discectomy for intracanalicular disc herniations at L5-S1 using a rigid working channel endoscope. Neurosurgery, 2006, 58(Suppl 1): ONS59-68.
6.	Choi G, Kim JS, Lokhande P, et al. Percutaneous endoscopic lumbar discectomy by transiliac approach: a case report. Spine, 2009, 34(12): E443-E446.
7.	查圆瑜, 金伟, 张树威, 等. 经皮椎间孔入路与椎板间入路脊柱内镜下髓核摘除术治疗 L5/S1 椎间盘突出症的疗效分析. 生物骨科材料与临床研究, 2017, 14(1): 64-68.
8.	陈长青, 王成, 王耀生, 等. 两种经皮内镜入路治疗 L5S1 椎间盘突出症的对比. 中国中医骨伤科杂志, 2016, 24(9): 25-28, 32.
9.	罗毅, 丁晓川, 侯伟光, 等. 经皮椎间孔镜后路椎板间与侧后方椎间孔入路治疗腰5/骶1椎间盘突出症对比研究. 西部医学, 2015, 27(6): 865-867.
10.	沈童. 经椎间孔入路和经椎板间入路内镜下腰椎间盘切除术治疗 L5-S1 椎间盘突出疗效比较. 杭州: 浙江大学, 2017.
11.	张金虎, 陈德喜, 张建旭, 等. 经皮椎间孔镜 TESSYS 技术与 PEID 技术治疗 L5S1 椎间盘突出症的疗效观察. 中国骨与关节损伤杂志, 2016, 31(9): 929-932.
12.	徐洲, 石磊, 楚磊, 等. 腰椎椎间盘突出症经椎板间和经椎间孔入路内镜治疗的比较研究. 脊柱外科杂志, 2013, 11(2): 97-100.
13.	Choi KC, Kim JS, Ryu KS, et al. Percutaneous endoscopic lumbar discectomy for L5-S1 disc herniation: transforaminal versus interlaminar approach. Pain Physician, 2013, 16(6): 547-556.
14.	Nie H, Zeng J, Song Y, et al. Percutaneous endoscopic lumbar discectomy for L5-S1 disc herniation via an interlaminar approach versus a transforaminal approach: a prospective randomized controlled study with 2-year follow up. Spine, 2016, 41(Suppl 19): B30-B37.
15.	Ahn Y, Lee SH, Park WM, et al. Posterolateral percutaneous endoscopic lumbar foraminotomy for L5-S1 foraminal or lateral exit zone stenosis. J Neurosurg, 2003, 99(Suppl 3): 320-323.
16.	Hoogland T, van den Brekel-Dijkstra K, Schubert M, et al. Endoscopic transforaminal discectomy for recurrent lumbar disc herniation: a prospective, cohort evaluation of 262 consecutive cases. Spine, 2008, 33(9): 973-978.
17.	Yeung AT, Yeung CA. Minimally invasive techniques for the management of lumbar disc herniation. Orthop Clin North Am, 2007, 38(3): 363-372.
18.	Choi KC, Park CK. Percutaneous endoscopic lumbar discectomy for L5-S1 disc herniation: consideration of the relation between the iliac crest and L5-S1 disc. Pain Physician, 2016, 19(2): E301-E308.
19.	Kim CH, Chung CK. Endoscopic interlaminar lumbar discectomy with splitting of the ligament flavum under visual control. J Spinal Disord Tech, 2012, 25(4): 210-217.
20.	Ahn Y, Kim CH, Lee JH, et al. Radiation exposure to the surgeon during percutaneous endoscopic lumbar discectomy: a prospective study. Spine, 2013, 38(7): 617-625.
21.	Sairyo K, Egawa H, Matsuura T, et al. State of the art: transforaminal approach for percutaneous endoscopic lumbar discectomy under local anesthesia. J Med Invest, 2014, 61(3-4): 217-225.
22.	Chen HT, Tsai CH, Chao SC, et al. Endoscopic discectomy of L5-S1 disc herniation via an interlaminar approach: Prospective controlled study under local and general anesthesia. Surg Neurol Int, 2011, 2: 93.
23.	王丹, 翟俊霞, 牟振云, 等. Meta 分析中的异质性及其处理方法. 中国循证医学杂志, 2009, 9(10): 1115-1118.
24.	Anello C, Fleiss JL. Exploratory or analytic meta-analysis: should we distinguish between them? J Clin Epidemiol, 1995, 48(1): 109-116.

1. Yeung AT, Tsou PM. Posterolateral endoscopic excision for lumbar disc herniation: surgical technique, outcome, and complications in 307 consecutive cases. Spine, 2002, 27(7): 722-731.
2. Yeung AT. Minimally invasive disc surgery with the Yeung Endoscopic Spine System (YESS). Surg Technol Int, 1999, 8: 267-277.
3. Hoogland T, Schubert M, Miklitz B, et al. Transforaminal posterolateral endoscopic discectomy with or without the combination of a low-dose chymopapain: a prospective randomized study in 280 consecutive cases. Spine, 2006, 31(24): E890-E897.
4. Ruetten S, Komp M, Godolias G. A new full-endoscopic technique for the interlaminar operation of lumbar disc herniations using 6-mm endoscopes: prospective 2-year results of 331 patients. Minim Invasive Neurosurg, 2006, 49(2): 80-87.
5. Choi G, Lee SH, Raiturker PP, et al. Percutaneous endoscopic interlaminar discectomy for intracanalicular disc herniations at L5-S1 using a rigid working channel endoscope. Neurosurgery, 2006, 58(Suppl 1): ONS59-68.
6. Choi G, Kim JS, Lokhande P, et al. Percutaneous endoscopic lumbar discectomy by transiliac approach: a case report. Spine, 2009, 34(12): E443-E446.
7. 查圆瑜, 金伟, 张树威, 等. 经皮椎间孔入路与椎板间入路脊柱内镜下髓核摘除术治疗 L5/S1 椎间盘突出症的疗效分析. 生物骨科材料与临床研究, 2017, 14(1): 64-68.
8. 陈长青, 王成, 王耀生, 等. 两种经皮内镜入路治疗 L5S1 椎间盘突出症的对比. 中国中医骨伤科杂志, 2016, 24(9): 25-28, 32.
9. 罗毅, 丁晓川, 侯伟光, 等. 经皮椎间孔镜后路椎板间与侧后方椎间孔入路治疗腰5/骶1椎间盘突出症对比研究. 西部医学, 2015, 27(6): 865-867.
10. 沈童. 经椎间孔入路和经椎板间入路内镜下腰椎间盘切除术治疗 L5-S1 椎间盘突出疗效比较. 杭州: 浙江大学, 2017.
11. 张金虎, 陈德喜, 张建旭, 等. 经皮椎间孔镜 TESSYS 技术与 PEID 技术治疗 L5S1 椎间盘突出症的疗效观察. 中国骨与关节损伤杂志, 2016, 31(9): 929-932.
12. 徐洲, 石磊, 楚磊, 等. 腰椎椎间盘突出症经椎板间和经椎间孔入路内镜治疗的比较研究. 脊柱外科杂志, 2013, 11(2): 97-100.
13. Choi KC, Kim JS, Ryu KS, et al. Percutaneous endoscopic lumbar discectomy for L5-S1 disc herniation: transforaminal versus interlaminar approach. Pain Physician, 2013, 16(6): 547-556.
14. Nie H, Zeng J, Song Y, et al. Percutaneous endoscopic lumbar discectomy for L5-S1 disc herniation via an interlaminar approach versus a transforaminal approach: a prospective randomized controlled study with 2-year follow up. Spine, 2016, 41(Suppl 19): B30-B37.
15. Ahn Y, Lee SH, Park WM, et al. Posterolateral percutaneous endoscopic lumbar foraminotomy for L5-S1 foraminal or lateral exit zone stenosis. J Neurosurg, 2003, 99(Suppl 3): 320-323.
16. Hoogland T, van den Brekel-Dijkstra K, Schubert M, et al. Endoscopic transforaminal discectomy for recurrent lumbar disc herniation: a prospective, cohort evaluation of 262 consecutive cases. Spine, 2008, 33(9): 973-978.
17. Yeung AT, Yeung CA. Minimally invasive techniques for the management of lumbar disc herniation. Orthop Clin North Am, 2007, 38(3): 363-372.
18. Choi KC, Park CK. Percutaneous endoscopic lumbar discectomy for L5-S1 disc herniation: consideration of the relation between the iliac crest and L5-S1 disc. Pain Physician, 2016, 19(2): E301-E308.
19. Kim CH, Chung CK. Endoscopic interlaminar lumbar discectomy with splitting of the ligament flavum under visual control. J Spinal Disord Tech, 2012, 25(4): 210-217.
20. Ahn Y, Kim CH, Lee JH, et al. Radiation exposure to the surgeon during percutaneous endoscopic lumbar discectomy: a prospective study. Spine, 2013, 38(7): 617-625.
21. Sairyo K, Egawa H, Matsuura T, et al. State of the art: transforaminal approach for percutaneous endoscopic lumbar discectomy under local anesthesia. J Med Invest, 2014, 61(3-4): 217-225.
22. Chen HT, Tsai CH, Chao SC, et al. Endoscopic discectomy of L5-S1 disc herniation via an interlaminar approach: Prospective controlled study under local and general anesthesia. Surg Neurol Int, 2011, 2: 93.
23. 王丹, 翟俊霞, 牟振云, 等. Meta 分析中的异质性及其处理方法. 中国循证医学杂志, 2009, 9(10): 1115-1118.
24. Anello C, Fleiss JL. Exploratory or analytic meta-analysis: should we distinguish between them? J Clin Epidemiol, 1995, 48(1): 109-116.

Chinese Journal of Evidence-Based Medicine

Efficacy and safety of PELD for L5/S1 disc herniation via transforaminal approach versus interlaminar approach: a meta-analysis

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content