Qin L, Jiang X, Zhao S, et al. A Comparison of Minimally Invasive Surgical Techniques and Standard Open Discectomy for Lumbar Disc Herniation: A Network Meta-analysis. Pain Physician. 2024 Mar;27(3):E305-E316. (Systematic review)

BACKGROUND: Lumbar disc herniation is a common spinal disease that causes low back pain; surgery is required when conservative treatment is ineffective. There is a growing demand for minimally invasive surgery in younger patient populations due to their fear of significant damage and a long recovery period following standard open discectomy. The development history of minimally invasive surgery is relatively short, and no gold standard has been established.

OBJECTIVES: We aimed to find, via a network meta-analysis, the best treatment for low back pain in younger patient populations.

STUDY DESIGN: Network meta-analysis.

METHODS: The PubMed, Embase, Cochrane Library, and Web of Science databases were searched. Data quality was evaluated using RevMan 5.3 (The Nordic Cochrane Centre for The Cochrane Collaboration), while STATA 14.0 (StataCorp LLC) was used for the network meta-analysis and to merge data on the Visual Analog Scale (VAS) score, Oswestry Disability Index (ODI) score, complication, blood loss, reoperation rate, and function score.

RESULTS: We included 50 randomized controlled trials, involving 7 interventions; heterogeneity and inconsistency were acceptable. Comparatively, microendoscopic discectomy and percutaneous endoscopic lumbar discectomy were the best surgical procedures from the aspects of VAS score and ODI score, while standard open discectomy was the worst one from the aspect of ODI score. Regarding complications, tubular discectomy was preferred with the fewest complications. Additionally, microendoscopic discectomy outperformed other surgical procedures in reducing blood loss and reoperation rate.

LIMITATIONS: First, follow-up data were not reported in all included studies, and the follow-up time varied from several months to 8 years, which affected the results accuracy of our study to some extent. Second, there were some nonsurgical factors that also affected the self-reported outcomes, such as rehabilitation and pain management, which also brought a certain bias in our study results.

CONCLUSIONS: Compared to standard open discectomy, minimally invasive surgical procedures not only achieve satisfactory efficacy, but also microendoscopic discectomy and percutaneous endoscopic lumbar discectomy can obtain a more satisfactory short-term VAS score and ODI score. Microendoscopic discectomy has significant advantages in blood loss and reoperation rate, and tubular discectomy has fewer postoperative complications.

Discipline Area Score
Physician 5 / 7
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Comments from MORE raters

Physician rater

For once, minimally invasive techniques do have advantages over more traditional ones.
Comments from PAIN+ CPN subscribers

Mrs. Lee Gardiner (4/22/2024 6:39 PM)

"Surgery is required when conservative treatment is ineffective." This is not necessarily so. People fail to progress from lumbar disc injuries for all sorts of reasons and there is still a poor link between MRi findings and clinical symptoms. Evidence-based pain management and encouragement to be active are the recommended managements for rehabilitation. Surgery does not just become an option because the client does not progress well with these interventions.