1
|
Lv S, Lv H, He Y, Xia X. Efficacy of Biportal Endoscopic Decompression for Lumbar Spinal Stenosis: A Meta-Analysis With Single-Arm Analysis and Comparative Analysis With Microscopic Decompression and Uniportal Endoscopic Decompression. Oper Neurosurg (Hagerstown) 2024; 27:158-173. [PMID: 38511959 DOI: 10.1227/ons.0000000000001097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 12/26/2023] [Indexed: 03/22/2024] Open
Abstract
BACKGROUND AND OBJECTIVE Biportal endoscopic decompression is a minimally invasive surgical technique for lumbar spinal stenosis (LSS). This meta-analysis aimed to evaluate the efficacy and safety of biportal endoscopic decompression through both a single-arm analysis and a comparative analysis. METHODS A comprehensive literature search was conducted to identify eligible studies reporting the outcomes of biportal endoscopic decompression for LSS. Single-arm analysis and comparisons with microscopic and uniportal endoscopic decompression were performed. Evaluated outcomes included visual analog scale (VAS) scores for back pain and leg pain, Oswestry Disability Index (ODI) scores, operation time, estimated blood loss, duration of hospital stay, and adverse events. RESULTS Single-arm analysis demonstrated significant improvements in VAS back pain, VAS leg pain, and ODI scores after biportal endoscopic decompression at postoperative 1-day to 36-month follow-up (all P < .001), compared with preoperative levels. The pooled mean single-level operation time was 71.44 min, and the pooled mean hospital stay was 3.63 days. The overall adverse event rate was 4.0%, with dural tear being the most common complication (3.0%). Compared with microscopic decompression, biportal endoscopic decompression showed significantly lower VAS back pain at 1-month ( P < .001) and 6-month ( P < .001) follow-up; lower VAS leg pain at 1-month ( P = .045) follow-up; lower ODI scores at 3-month ( P < .001), 12-month ( P = .017), and >12-month ( P = .007) follow-up; lower estimated blood loss ( P = .003); and shorter hospital stay ( P < .001). Adverse event rates did not differ between the techniques. No significant differences were observed between biportal endoscopic and uniportal endoscopic decompression groups for most efficacy and safety outcomes. CONCLUSION Biportal endoscopic decompression emerges as a safe and effective alternative for LSS, presenting potential advantages over the microscopic technique and comparable efficacy with the uniportal endoscopic technique.
Collapse
Affiliation(s)
- Shuangwen Lv
- Department of Orthopedic Ward One, The Second Affiliated Hospital of Henan University of Science and Technology, Luoyang , Henan , China
| | - Haiwen Lv
- Department of Orthopedic Ward One, The Second Affiliated Hospital of Henan University of Science and Technology, Luoyang , Henan , China
| | - Yupeng He
- Department of Orthopedic Ward One, The Second Affiliated Hospital of Henan University of Science and Technology, Luoyang , Henan , China
| | - Xiansheng Xia
- Department of Orthopaedics, Dongguan Children's Hospital, Dongguan , Guangdong , China
| |
Collapse
|
2
|
Unilateral Biportal Endoscopic Discectomy versus Microendoscopic Discectomy for the Treatment of Lumbar Spinal Stenosis: A Systematic Review and Meta-Analysis. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:7667463. [PMID: 36188105 PMCID: PMC9519329 DOI: 10.1155/2022/7667463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 08/12/2022] [Accepted: 08/26/2022] [Indexed: 11/18/2022]
Abstract
Objective In minimally invasive spinal surgery, the treatment of lumbar spinal stenosis with microendoscopic discectomy (MED) or unilateral biportal endoscopic discectomy (UBED) shows effective results, but which is more effective is controversial. Our study aimed to evaluate the efficacy and safety of UBED versus MED in the treatment of lumbar spinal stenosis by a systematic review and meta-analysis, so as to provide reference for the promotion of UBED in clinical practice. Methods The multiple databases like PubMed, EMBASE, Web of Science, Cochrane Library, Chinese National Knowledge Databases, Chinese BioMedical Database, and Wanfang Database were used to search for the relevant studies. Review Manager 5.4 was adopted to estimate the effects of the results among selected articles. Odds ratio (OR) and mean difference (MD) with 95% confidence intervals (CIs) were used to estimate the overall pooled effect. Subgroup analysis, forest plots, funnel plots and Egger's test for the articles included were also conducted. Results Three randomized clinical trials and seven cohort studies were finally retrieved, these studies included 685 and 829 patients in the UBED and MED groups, respectively. There were no differences in terms of operation time (MD = -0.92, P =0.72), estimated blood loss (MD = -26.31, P =0.08), complications (MD =0.81, P =0.38) and Oswestry Disability Index (ODI) score (P >0.05 in four subgroup) between the two groups. The visual analog scale (VAS) score of back pain in the UBED group was better than MED group only at 6 months (MD = -0.23, P =0.006) after operation, the VAS score of leg pain in the UBED group was better than that of MED group at 3 mouths (MD = -0.22, P =0.002) and 6 months (MD = -0.24, P =0.006) after operation, the UBED group had a less postoperative length of stay than the MED group (MD = -1.85, P <0.001). The bias analysis showed that there was no potential publication bias in the included literature. Conclusion This study showed that compared with MED, UBED has the advantages of short hospital stay and good short-term curative effect, but there is no significant difference in long-term efficacy and safety, they can be replaced by each other in clinical application.
Collapse
|
3
|
Du WJ, Wang J, Wang Q, Yuan LJ, Lu ZX. Endoscopic modified total laminoplasty for symptomatic lumbar spinal stenosis. J Spinal Cord Med 2022; 45:58-64. [PMID: 32496889 PMCID: PMC8890573 DOI: 10.1080/10790268.2020.1762827] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Context/objective: At present, there is no consensus on the most effective surgical method for treating symptomatic lumbar spinal stenosis (LSS). Total laminectomy, which is frequently used at this time, destroys the posterior midline structure, causing many postoperative complications. We have designed a new surgical approach instead of total laminectomy. In this paper, we aimed to describe the surgical method of endoscopic modified total laminectomy for lumbar spinal stenosis as well as to explore its early efficacy.Participants: Patients with symptomatic LSS who underwent endoscopic modified total laminoplasty between August 2016 and August 2017 were eligible for our study.Outcome measures: Before surgery and one year after surgery, we measured lower limb pain and back pain by visual analog scale (VAS), disability via Oswestry Disability Index (ODI), and severity of back pain according to the Japanese Orthopedic Association Score for Back Pain (JOA), while any complications were also assessed.Results: Endoscopic modified total laminoplasty was performed on 22 LSS patients, including eight males and 14 females(mean age = 59.3 ± 9.6 years). We found statistically significant differences before and one year after surgery for VAS lower limb pain and back pain, ODI and JOA scores(P < 0.001). Complications included intraoperative dural tears(n = 1),and weak fusion between the lamina and the vertebral body (n = 1).Conclusion: Endoscopic modified total laminectomy is a promising surgical approach which reduces patient suffering and improves patient quality of life.
Collapse
Affiliation(s)
- Wen-Jie Du
- The Fifth Ward of the Orthopedics Department, The First Affiliated Hospital of Zhengzhou University, Zhengzhou City, Henan Province, People’s Republic of China
| | - Jue Wang
- The Fifth Ward of the Orthopedics Department, The First Affiliated Hospital of Zhengzhou University, Zhengzhou City, Henan Province, People’s Republic of China,Correspondence to: Jue Wang, The First Affiliated Hospital of Zhengzhou University, Zhengzhou City, Henan Province, People’s Republic of China; 8613526842169.
| | - Qi Wang
- The Department of Pain, Shanxi Bethune hospital, Taiyuan City, Shanxi Province, People’s Republic of China
| | - Lian-Jing Yuan
- The Fifth Ward of the Orthopedics Department, The First Affiliated Hospital of Zhengzhou University, Zhengzhou City, Henan Province, People’s Republic of China
| | - Zhi-Xiang Lu
- The Fifth Ward of the Orthopedics Department, The First Affiliated Hospital of Zhengzhou University, Zhengzhou City, Henan Province, People’s Republic of China
| |
Collapse
|
4
|
Muthu S, Ramakrishnan E, Chellamuthu G. Is Endoscopic Discectomy the Next Gold Standard in the Management of Lumbar Disc Disease? Systematic Review and Superiority Analysis. Global Spine J 2021; 11:1104-1120. [PMID: 32935576 PMCID: PMC8351066 DOI: 10.1177/2192568220948814] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
STUDY DESIGN Systematic review and meta-analysis. OBJECTIVES We performed this meta-analysis to evaluate whether endoscopic discectomy (ED) shows superiority compared with the current gold standard of microdiscectomy (MD) in management of lumbar disc disease. MATERIALS AND METHODS We conducted independent and duplicate electronic database search including PubMed, Embase, and Cochrane Library from 1990 till April 2020 for studies comparing ED and MD in the management of lumbar disc disease. Analysis was performed in R platform using OpenMeta[Analyst] software. RESULTS We included 27 studies, including 11 randomized controlled trials (RCTs), 7 nonrandomized prospective, and 9 retrospective studies involving 4018 patients in the meta-analysis. We stratified the results based on the study design. Considering the heterogeneity in some results between study designs, we weighed our conclusion essentially based on results of RCTs. On analyzing the RCTs, superiority was established at 95% confidence interval for ED compared with MD in terms of functional outcomes like Oswestry Disability Index (ODI) score (P = .008), duration of surgery (P = .023), and length of hospital stay (P < .001) although significant heterogeneity was noted. Similarly, noninferiority to MD was established by ED in other outcomes like visual analogue scale score for back pain (P = .860) and leg pain (P = .495), MacNab classification (P = .097), recurrences (P = .993), reoperations (P = .740), and return-to-work period (P = .748). CONCLUSION Our meta-analysis established the superiority of endoscopic discectomy in outcome measures like ODI score, duration of surgery, overall complications, length of hospital stay and noninferiority in other measures analyzed. With recent advances in the field of ED, the procedure has the potential to take over the place of MD as the gold standard of care in management of lumbar disc disease.
Collapse
Affiliation(s)
- Sathish Muthu
- Government Hospital, Karur, Tamil Nadu, India
- Orthopaedic Research Group, Coimbatore, Tamil Nadu, India
- Sathish Muthu, Government Hospital, Velayuthampalayam, Karur, 639117, Tamil Nadu, India.
| | - Eswar Ramakrishnan
- Orthopaedic Research Group, Coimbatore, Tamil Nadu, India
- Madras Medical College, Chennai, Tamil Nadu, India
- Rajiv Gandhi Government General Hospital, Chennai, Tamil Nadu, India
| | - Girinivasan Chellamuthu
- Orthopaedic Research Group, Coimbatore, Tamil Nadu, India
- Ganga Hospitals, Coimbatore, Tamil Nadu, India
| |
Collapse
|
5
|
Meyer G, DA Rocha ID, Cristante AF, Marcon RM, Coutinho TP, Torelli AG, Petersen PA, Letaif OB, DE Barros Filho TEP. Percutaneous Endoscopic Lumbar Discectomy Versus Microdiscectomy for the Treatment of Lumbar Disc Herniation: Pain, Disability, and Complication Rate-A Randomized Clinical Trial. Int J Spine Surg 2020; 14:72-78. [PMID: 32128306 DOI: 10.14444/7010] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Purpose The objective was to compare the traditional microdiscectomy with percutaneous endoscopic lumbar discectomy for the treatment of disc herniations regarding pain, disability, and complications. Methods Randomized clinical trial with 47 patients with disc herniations treated with 2 different surgical techniques: traditional microdiscectomy or percutaneous endoscopic lumbar discectomy. Forty-seven patients were divided into 2 groups and monitored for 12 months. Irradiated and low back pain were evaluated with the visual analog scale. Surgery complications were recorded. Results After surgery, the sciatica and disability improved significantly but without significant differences between the groups. Improvements in back pain were significant until the third month. There were no statistical differences between groups regarding recurrence, infection, and the need for reoperation. Conclusions Endoscopic discectomy results are similar to those of conventional microdiscectomy regarding pain and disability improvement. Postoperative lumbar pain is less intense with endoscopic discectomy than conventional microdiscectomy only during the first 3 months. Endoscopic discectomy is a safe and efficient alternative to microdiscectomy. Clinical Trials Trial protocol registration number: RBR-5symrd (http://www.ensaiosclinicos.gov.br).
Collapse
Affiliation(s)
- Guilherme Meyer
- Spine Surgery Division, Instituto de Ortopedia e Traumatologia da Faculdade de Medicina da Universidade de São Paulo, FMUSP, São Paulo, Brazil.,Spine Surgery Division, Instituto Vita, São Paulo, Brazil
| | - Ivan Dias DA Rocha
- Spine Surgery Division, Instituto de Ortopedia e Traumatologia da Faculdade de Medicina da Universidade de São Paulo, FMUSP, São Paulo, Brazil
| | - Alexandre Fogaça Cristante
- Spine Surgery Division, Instituto de Ortopedia e Traumatologia da Faculdade de Medicina da Universidade de São Paulo, FMUSP, São Paulo, Brazil
| | - Raphael Martus Marcon
- Spine Surgery Division, Instituto de Ortopedia e Traumatologia da Faculdade de Medicina da Universidade de São Paulo, FMUSP, São Paulo, Brazil
| | - Thiago Pereira Coutinho
- Spine Surgery Division, Instituto de Ortopedia e Traumatologia da Faculdade de Medicina da Universidade de São Paulo, FMUSP, São Paulo, Brazil
| | - Alessandro Gonzalez Torelli
- Spine Surgery Division, Instituto de Ortopedia e Traumatologia da Faculdade de Medicina da Universidade de São Paulo, FMUSP, São Paulo, Brazil
| | - Pedro Araujo Petersen
- Spine Surgery Division, Instituto de Ortopedia e Traumatologia da Faculdade de Medicina da Universidade de São Paulo, FMUSP, São Paulo, Brazil
| | - Olavo Biraghi Letaif
- Spine Surgery Division, Instituto de Ortopedia e Traumatologia da Faculdade de Medicina da Universidade de São Paulo, FMUSP, São Paulo, Brazil
| | | |
Collapse
|