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Reheman S, Meng X, Abudurexiti T, Haibier A, Sheng W. Limited discectomy versus aggressive discectomy by spinal endoscopy with the transforaminal approach for lumbar disc herniation: a retrospective study. BMC Musculoskelet Disord 2024; 25:416. [PMID: 38807128 PMCID: PMC11131275 DOI: 10.1186/s12891-024-07498-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Accepted: 05/06/2024] [Indexed: 05/30/2024] Open
Abstract
OBJECTIVE To compare the clinical and radiological outcomes of limited discectomy (LD) and aggressive discectomy (AD) performed via spinal endoscopy using the transforaminal approach in patients with lumbar disc herniation(LDH) METHODS: We conducted a retrospective review of patients who underwent percutaneous endoscopic transforaminal discectomy (PETD) at the L4-L5 lumbar spine segments in our department from January 2017 to December 2020. The follow-up period extended to 24 months postoperatively. Patients were categorized into the LD and AD groups based on the extent of intraoperative disc removal. We retrospectively collected and analyzed clinical and radiological data. RESULTS The study followed 65 patients, with 36 in the LD group and 29 in the AD group. No statistically significant differences were noted in recurrence rates, the excellent and good Macnab rates, preoperative Disc Height Index (DHI), and preoperative Modic changes between the groups (P >0.05). However, significant differences were observed in operation duration, postoperative DHI and postoperative Modic change (P<0.05). No significant differences in Visual Analog Scale (VAS) and Oswestry Disability Index (ODI) scores were detected between the groups preoperatively, or one and two years postoperatively (P>0.05). Nevertheless, notable differences in VAS and ODI scores were present one month postoperatively (P<0.05). CONCLUSION As a conventional surgical method for treating LDH, PETD can achieve satisfactory clinical results in both LD and AD, with no significant variance in recurrence rates. However, AD is associated with longer operation times, and greater postoperative reductions in DHI and greater postoperative Modic changes compared to LD.
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Affiliation(s)
- Sulaiman Reheman
- First Affiliated Hospital of Xinjiang Medical University, No.137 Liyushan Road, Urumqi, Xinjiang Uygur Autonomous Region, People's Republic of China
- Sixth Affiliated Hospital of Xinjiang Medical University, Xinjiang Uygur Autonomous Region, Urumqi, People's Republic of China
| | - XiangYu Meng
- Sixth Affiliated Hospital of Xinjiang Medical University, Xinjiang Uygur Autonomous Region, Urumqi, People's Republic of China
| | - Tuerhongjiang Abudurexiti
- Sixth Affiliated Hospital of Xinjiang Medical University, Xinjiang Uygur Autonomous Region, Urumqi, People's Republic of China
| | - Abuduwupuer Haibier
- Sixth Affiliated Hospital of Xinjiang Medical University, Xinjiang Uygur Autonomous Region, Urumqi, People's Republic of China
| | - Weibin Sheng
- First Affiliated Hospital of Xinjiang Medical University, No.137 Liyushan Road, Urumqi, Xinjiang Uygur Autonomous Region, People's Republic of China.
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Xu G, Zhang X, Zhu M, Yan Y, Zhang Y, Zhang J, Li F, Xu M, Zhang D. Clinical efficacy of transforaminal endoscopic discectomy in the treatment of recurrent lumbar disc herniation: a single-center retrospective analysis. BMC Musculoskelet Disord 2023; 24:24. [PMID: 36631884 PMCID: PMC9835219 DOI: 10.1186/s12891-023-06148-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Accepted: 01/09/2023] [Indexed: 01/13/2023] Open
Abstract
PURPOSE To investigate the clinical efficacy of transforaminal endoscopic discectomy (TED) in treating recurrent lumbar disc herniation. METHODS Clinical datal of 31 patients who were hospitalized in the Department of Pain Management, First Affiliated Hospital of Nanchang University, between 2015 and 2018 due to recurrent lumbar disc herniation were collected and analyzed retrospectively. Visual analogue scale (VAS) scores and Japanese Orthopedic Association (JOA) scores were used to assess alterations of patients' leg pain intensity and nerve function, respectively. The Modified MacNab criteria were used to evaluate patients' excellent and good rates. RESULTS Compared to clinical data before surgery, there was a significant reduction in VAS scores (P < 0.01) along with a significant improvement in JOA scores (P < 0.01) at 2 years after revision surgery. The patients' excellent and good rates were 83.9% at the 2 years after surgery. CONCLUSION The TED is safe and effective in the long term and is applicable to the treatment of recurrent lumbar disc herniation.
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Affiliation(s)
- Gang Xu
- grid.412604.50000 0004 1758 4073Department of Pain Medicine, The First Affiliated Hospital of Nanchang University, Nanchang, 330006 People’s Republic of China ,grid.412604.50000 0004 1758 4073JXHC Key Laboratory of Neuropathic Pain, (The First Affiliated Hospital of Nanchang University), Nanchang, 330006 People’s Republic of China
| | - Xuexue Zhang
- grid.412604.50000 0004 1758 4073Department of Pain Medicine, The First Affiliated Hospital of Nanchang University, Nanchang, 330006 People’s Republic of China ,grid.412604.50000 0004 1758 4073JXHC Key Laboratory of Neuropathic Pain, (The First Affiliated Hospital of Nanchang University), Nanchang, 330006 People’s Republic of China
| | - Mengye Zhu
- grid.412604.50000 0004 1758 4073Department of Pain Medicine, The First Affiliated Hospital of Nanchang University, Nanchang, 330006 People’s Republic of China ,grid.412604.50000 0004 1758 4073JXHC Key Laboratory of Neuropathic Pain, (The First Affiliated Hospital of Nanchang University), Nanchang, 330006 People’s Republic of China
| | - Yi Yan
- grid.412604.50000 0004 1758 4073Department of Pain Medicine, The First Affiliated Hospital of Nanchang University, Nanchang, 330006 People’s Republic of China ,grid.412604.50000 0004 1758 4073JXHC Key Laboratory of Neuropathic Pain, (The First Affiliated Hospital of Nanchang University), Nanchang, 330006 People’s Republic of China
| | - Yong Zhang
- grid.412604.50000 0004 1758 4073Department of Pain Medicine, The First Affiliated Hospital of Nanchang University, Nanchang, 330006 People’s Republic of China ,grid.412604.50000 0004 1758 4073JXHC Key Laboratory of Neuropathic Pain, (The First Affiliated Hospital of Nanchang University), Nanchang, 330006 People’s Republic of China
| | - Jinjin Zhang
- grid.412604.50000 0004 1758 4073Department of Pain Medicine, The First Affiliated Hospital of Nanchang University, Nanchang, 330006 People’s Republic of China ,grid.412604.50000 0004 1758 4073JXHC Key Laboratory of Neuropathic Pain, (The First Affiliated Hospital of Nanchang University), Nanchang, 330006 People’s Republic of China
| | - Fan Li
- grid.412604.50000 0004 1758 4073Department of Pain Medicine, The First Affiliated Hospital of Nanchang University, Nanchang, 330006 People’s Republic of China ,grid.412604.50000 0004 1758 4073JXHC Key Laboratory of Neuropathic Pain, (The First Affiliated Hospital of Nanchang University), Nanchang, 330006 People’s Republic of China
| | - Mu Xu
- grid.412604.50000 0004 1758 4073Department of Pain Medicine, The First Affiliated Hospital of Nanchang University, Nanchang, 330006 People’s Republic of China ,grid.412604.50000 0004 1758 4073JXHC Key Laboratory of Neuropathic Pain, (The First Affiliated Hospital of Nanchang University), Nanchang, 330006 People’s Republic of China
| | - Daying Zhang
- grid.412604.50000 0004 1758 4073Department of Pain Medicine, The First Affiliated Hospital of Nanchang University, Nanchang, 330006 People’s Republic of China ,grid.412604.50000 0004 1758 4073JXHC Key Laboratory of Neuropathic Pain, (The First Affiliated Hospital of Nanchang University), Nanchang, 330006 People’s Republic of China
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Jiang S, Li Q, Wang H. Comparison of the clinical efficacy of percutaneous transforaminal endoscopic discectomy and traditional laminectomy in the treatment of recurrent lumbar disc herniation. Medicine (Baltimore) 2021; 100:e25806. [PMID: 34397681 PMCID: PMC8322506 DOI: 10.1097/md.0000000000025806] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 04/15/2021] [Indexed: 01/04/2023] Open
Abstract
A few years ago, percutaneous transforaminal endoscopic discectomy (PTED) began to prevail in clinical treatment of recurrent lumbar disc herniation (RLDH), whereas traditional laminectomy (TL) was treated earlier in RLDH than PTED. This study aimed to compare the clinical efficacy of PTED and TL in the treatment of RLDH.Between November 2012 and October 2017, retrospective analysis of 48 patients with RLDH who were treated at the Cancer Hospital, Chinese Academy of Sciences, Hefei and Department of Orthopaedics, Second Affiliated Hospital of Anhui Medical University. Perioperative evaluation indicators included operation time, the intraoperative blood loss, length of incision and hospitalization time. Clinical outcomes were measured preoperatively, and at 1 days, 3 months, and 12 months postoperatively. The patients' lower limb pain was evaluated using Oswestry disability index (ODI) and visual analog scale (VAS) scores. The ODI is the most widely-used assessment method internationally for lumbar or leg pain at present. Every category comprises 6 options, with the highest score for each question being 5 points. higher scores represent more serious dysfunction. The VAS is the most commonly-used quantitative method for assessing the degree of pain in clinical practice. The measurement method is to draw a 10 cm horizontal line on a piece of paper, 1 end of which is 0, indicating no pain, which the other end is 10, which means severe pain, and the middle part indicates different degree of pain.Compared with the TL group, the operation time, postoperative bed-rest time, and hospitalization time of the PTED group were significantly shorter, and the intraoperative blood loss was also reduced. These differences were statistically significant (P < .01). There were no significant differences in VAS or ODI scores between the two groups before or after surgery (P > .05).PTED and TL have similar clinical efficacy in the treatment of RLDH, but PTED can shorten the operation time, postoperative bed-rest time and hospitalization time, and reduce intraoperative blood loss, so the PTED is a safe and effective surgical method for the treatment of RLDH than TL, but more randomized controlled trials are still required to further verify these conclusions.
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Affiliation(s)
- Shifeng Jiang
- Department of Orthopaedics, Cancer Hospital, Chinese Academy of Sciences, Hefei, Shushan lake road No.350, shushan district, hefei city, Anhui Province, china
| | - Qingning Li
- Department of Orthopaedics, The Second Affiliated Hospital of Anhui Medical University, 678 Furong Road, Hefei, Anhui, China
| | - Hongzhi Wang
- Department of Orthopaedics, Cancer Hospital, Chinese Academy of Sciences, Hefei, Shushan lake road No.350, shushan district, hefei city, Anhui Province, china
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Abstract
OBJECTIVE To investigate the prevalence and outcomes of surgery for lumbar disc herniation in professional football players. DESIGN Retrospective case series. SETTING Sports rehabilitation center. PARTICIPANTS A period of 10 seasons of the Italian Football First League (Serie A) was retrospectively investigated. Thirty-three teams (for a total of 1960 players) took turns in the 10 seasons, and 42 team doctors were requested to provide information about the number of players who underwent surgery for lumbar disc herniation. INTERVENTION Survey distributed to team doctors. MAIN OUTCOME MEASURES Prevalence and match incidence of the lumbar discectomy, proportion of players returning to competition after surgery, recovery time and preintervention and postintervention number of appearances in official matches were analyzed. RESULTS Eleven players underwent the surgical intervention during the considered period. The prevalence of the surgical treatment was 0.6%, whereas the match incidence was 0.09 cases/1000 match hours. All players returned to competitions 6.0 (3.5-7.7) months after surgery, with no significant difference between different roles. The number of appearances in official matches was comparable during the seasons before and after surgery. CONCLUSIONS The lumbar discectomy must be considered a rare surgical procedure performed in professional football players. All players returned to competitions after surgery. The postintervention number of appearances in official matches was comparable with the preintervention one.
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Dave BR, Degulmadi D, Krishnan A, Mayi S. Risk Factors and Surgical Treatment for Recurrent Lumbar Disc Prolapse: A Review of the Literature. Asian Spine J 2020; 14:113-121. [PMID: 31608614 PMCID: PMC7010513 DOI: 10.31616/asj.2018.0301] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Accepted: 03/10/2019] [Indexed: 02/05/2023] Open
Abstract
We aim to present the current evidence on various risk factors and surgical treatment modalities for recurrent lumbar disc herniation (rLDH). Using PubMed, a literature search was performed using the Mesh terms "recurrent disc prolapse," "herniated lumbar disc," "risk factors," and "treatment." Articles that were published between January 2010 and May 2017 were selected for further screening. A search conducted through PubMed identified 213 articles that met the initial screening criteria. Detailed analyses showed that 34 articles were eligible for inclusion in this review. Sixteen articles reported the risk factors associated with rLDH. Decompression alone as a treatment option was studied in seven articles, while 11 articles focused on different types of fusion surgery (anterior lumbar interbody fusion, posterior lumbar interbody fusion, open transforaminal lumbar interbody fusion [TLIF], and minimally invasive surgery-TLIF). Management of the rLDH requires consideration of the possible risk factors present in individual patients before primary and at the time of second surgery. Both, minimally invasive and conventional open procedures are comparably effective in relieving leg pain, and minimally invasive techniques offer advantage over the other technique in terms of tissue sparing. Non-fusion surgeries involve the risk of lumbar disc herniation re-recurrence, and the patient may require a third (fusion) surgery.
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Affiliation(s)
- Bharat R. Dave
- Stavya Spine Hospital and Research Institute, Ahmedabad, India
| | - Devanand Degulmadi
- Stavya Spine Hospital and Research Institute, Ahmedabad, India
- Corresponding author: Devanand Degulmadi Stavya Spine Hospital and Research Institute, Mithakali, Ahmedabad 380007, India Tel: +91-7874444091, Fax: +91-079-2656-5657, E-mail:
| | - Ajay Krishnan
- Stavya Spine Hospital and Research Institute, Ahmedabad, India
| | - Shivanand Mayi
- Stavya Spine Hospital and Research Institute, Ahmedabad, India
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Hao Y, Liu T, Yu L, Ma C, Liu Y, Li Z, Zhang D. [Percutaneous transforaminal endoscopic discectomy combined with Coflex interspinous process dynamic reconstruction system in treatment of youth lumbar disc herniation]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2017; 31:191-196. [PMID: 29786252 DOI: 10.7507/1002-1892.201608062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To evaluate the effectiveness of percutaneous transforaminal endoscopic discectomy (PTED) combined with Coflex interspinous process dynamic reconstruction system for the treatment of youth lumbar disc herniation (LDH). Methods The clinical data of 52 patients with LDH treated by PTED combined with Coflex were retrospectively analyzed between February 2013 and March 2015. The involved segments were L 4, 5 in 30 cases and L 5, S 1 in 22 cases. In 30 patients at L 4, 5 level, there were 18 males and 12 females with an average age of 25 years (range, 18-34 years) and a mean disease duration of 10 months (range, 6-16 months). In 22 patients at L 5, S 1 level, there were 10 males and 12 females with an average age of 25.5 years (range, 19-32 years) and a mean disease duration of 12 months (range, 6-18 months). The operation time and intraoperative blood loss were recorded. Oswestry disability index (ODI) and Japanese Orthpoaedic Association (JOA) score were used for effectiveness assessment. Radiograpic indexes were calculated on X-ray films before operation and final follow-up, including ventral intervertebral space height (VH), dorsal intervertebral space height (DH), intervertebral foramen height (IFH), the range of motion (ROM) of involved segment, and the ROM of upper adjacent segment. Results The operations were successfully completed in 52 patients. The operation time and intraoperative blood loss were (89.7±16.5) minutes and (42.7±11.3) mL in patients at L 4, 5 level, and were (94.6±18.2) minutes and (47.6±13.4) mL in patients at L 5, S 1 level. Incisions healed by first intention. All patients were followed up 12-18 months (mean,16 months) in patients at L 4, 5 level and 12-20 months (mean, 17 months) in patients at L 5, S 1 level. At final follow-up, ODI, and JOA score were significantly improved when compared with preoperative ones in all patients ( P<0.05). X-ray films showed no complication of Coflex loosening, spinous process fracture, or articular process fracture occurred. At final follow-up, VH, DH, and IFH were significantly improved when compared with preoperative ones in all patients ( P<0.05), and the ROM of involved segment was significantly reduced compared with preoperative one ( P<0.05), but the ROM of upper adjacent segment showed no significant difference when compared with preoperative one ( P>0.05). Conclusion PTED combined with Coflex is a safe and effective minimally invasive surgery in treating youth LDH; however, it still needs further clinical studies.
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Affiliation(s)
- Yingjie Hao
- Department of Orthopedics, the First Affiliated Hospital of Zhengzhou University, Zhengzhou Henan, 450052,
| | - Tao Liu
- Department of Orthopedics, the First Affiliated Hospital of Zhengzhou University, Zhengzhou Henan, 450052, P.R.China
| | - Lei Yu
- Department of Orthopedics, the First Affiliated Hospital of Zhengzhou University, Zhengzhou Henan, 450052, P.R.China
| | - Caoyuan Ma
- Department of Orthopedics, the First Affiliated Hospital of Zhengzhou University, Zhengzhou Henan, 450052, P.R.China
| | - Yawei Liu
- Department of Orthopedics, the First Affiliated Hospital of Zhengzhou University, Zhengzhou Henan, 450052, P.R.China
| | - Zhilei Li
- Department of Orthopedics, the First Affiliated Hospital of Zhengzhou University, Zhengzhou Henan, 450052, P.R.China
| | - Di Zhang
- Department of Orthopedics, the First Affiliated Hospital of Zhengzhou University, Zhengzhou Henan, 450052, P.R.China
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Drazin D, Ugiliweneza B, Al-Khouja L, Yang D, Johnson P, Kim T, Boakye M. Treatment of Recurrent Disc Herniation: A Systematic Review. Cureus 2016; 8:e622. [PMID: 27382530 PMCID: PMC4922511 DOI: 10.7759/cureus.622] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Intervertebral disc herniation is one of the most common causes of back and extremity pain. The most commonly used surgical treatment is lumbar discectomy. About 0.5-25% go on to develop recurrent disc herniation (rDH) after a successful first discectomy. Currently, there aren't any guidelines to assist surgeons in determining which approach is most appropriate to treat rDH. A recent survey showed significant heterogeneity among surgeons regarding treatment options for rDH. It remains unclear which methods lead to better outcomes, as there are no comparative studies with a sufficient level of evidence. In this study, we aimed to perform a systematic review to compare treatment options for rDH and determine if one intervention provides better outcomes than the other; more specifically, whether outcome differences exist between discectomy alone and discectomy with fusion. We applied the PICOS (participants, intervention, comparison, outcome, study design) format to develop this systematic review through PubMed. Twenty-seven papers from 1978-2014 met our inclusion criteria and were included in the analysis. Nine papers reported outcomes after discectomy and seven of them showed good or excellent outcomes (70.60%-89%). Ten papers reported on minimally invasive discectomy. The percent change in visual analog scale (VAS) ranged from -50.77% to -86.57%, indicating an overall pain reduction. Four studies out of the ten reported good or excellent outcomes (81% to 90.2%). Three studies looked at posterolateral fusion. Three studies analyzed posterior lumbar interbody fusion. For one study, we found the VAS percentage change to be -46.02%. All reported good to excellent outcomes. Six studies evaluated the transforaminal lumbar interbody fusion. All reported improvement in pain. Four used VAS, and we found the percent change to be -54% to -86.5%. The other two used the Japanese Orthopedic Association (JOA) score, and we found the percent change to be 68.3% to 93.3%. We did not find enough evidence to support any significant difference in outcomes between discectomy alone and discectomy with fusion. The limitation of our study includes the lack of standardized outcomes reporting in the literature. However, reviewing the selected articles shows that fusion may have a greater improvement in pain compared to reoperation without fusion. Nonetheless, our study shows that further and more in-depth investigation is needed on the of treatment of rDH.
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Affiliation(s)
- Doniel Drazin
- Department of Neurosurgery, Cedars-Sinai Medical Center
| | | | | | - Dongyan Yang
- Department of Epidemiology and Population Health, University of Louisville
| | | | - Terrence Kim
- Deparment of Orthopedics, Cedars-Sinai Medical Center
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Ran J, Hu Y, Zheng Z, Zhu T, Zheng H, Jing Y, Xu K. Comparison of discectomy versus sequestrectomy in lumbar disc herniation: a meta-analysis of comparative studies. PLoS One 2015; 10:e0121816. [PMID: 25815514 PMCID: PMC4376728 DOI: 10.1371/journal.pone.0121816] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Accepted: 02/04/2015] [Indexed: 11/30/2022] Open
Abstract
Background Lumbar disc removal is currently the standard treatment for lumbar disc herniation. No consensus has been achieved whether aggressive disc resection with curettage (discectomy) versus conservative removal of the offending disc fragment alone (sequestrectomy) provides better outcomes. This study aims to compare the reherniation rate and clinical outcomes between discectomy and sequestrectomy by literature review and a meta-analysis. Methods A systematic search of PubMed, Medline, Embase and the Cochrane Library was performed up to June 1, 2014. Outcomes of interest assessing the two techniques included demographic and clinical baseline characteristics, perioperative variables, complications, recurrent herniation rate and post-operative functional outcomes. Results Twelve eligible trials evaluating discectomy vs sequestrectomy were identified including one randomized controlled study, five prospective and six retrospective comparative studies. By contrast to discectomy, sequestrectomy was associated with significantly less operative time (p<0.001), lower visual analogue scale (VAS) for low back pain (p<0.05), less post-operative analgesic usage (p<0.05) and better patients’ satisfaction (p<0.05). Recurrent herniation rate, reoperation rate, intraoperative blood loss, hospitalization duration and VAS for sciatica were without significant difference. Conclusions According to our pooled data, sequestrectomy entails equivalent reherniation rate and complications compared with discectomy but maintains a lower incidence of recurrent low back pain and higher satisfactory rate. High-quality prospective randomized controlled trials are needed to firmly assess these two procedures.
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Affiliation(s)
- Jisheng Ran
- Department of Orthopedic Surgery, 2nd Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Yejun Hu
- Department of Orthopedic Surgery, 2nd Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Zefeng Zheng
- Department of Orthopedic Surgery, 2nd Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Ting Zhu
- Department of Orthopedic Surgery, 2nd Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Huawei Zheng
- Department of Orthopedic Surgery, 2nd Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Yibiao Jing
- Department of Orthopedic Surgery, 2nd Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Kan Xu
- Department of Orthopedic Surgery, 2nd Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
- * E-mail:
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