Department of Pain Management, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, China; Wuhan University Zhongnan Hospital, China.
Wuhan University Zhongnan Hospital, China.
Pain Physician. 2017 Sep;20(6):E863-E871.
The number of interventions on intervertebral discs rapidly increased and the treatment options for lumbar disc surgery quickly evolved. It is important that the safety and efficacy of all new innovative procedures be compared with currently accepted forms of treatment; however, the previous pairwise meta-analyses could not develop the hierarchy of these treatments.
The purpose of the study is to perform a network meta-analysis to evaluate the clinical results of 7 surgical interventions for the treatment of lumbar disc herniation.
Network meta-analysis of randomized controlled trials (RCTs) for multiple treatment comparisons of lumbar disc herniation.
We performed a Bayesian-framework network meta-analysis of RCTs to compare 7 surgical interventions for people with lumbar disc herniation. The eligible RCTs were identified by searching Embase, Pubmed, the Cochrane Central Register of Controlled Trials (CENTRAL), and Google scholar. Data from 3 outcomes (success, complications, and reoperation rate) were independently extracted by 2 authors.
A total of 29 RCTs including 3,146 participants were finally included into this article. Our meta-analysis provides hierarchies of these 7 interventions. For the success rate the rank probability (from best to worst): percutaneous endoscopic lumber discectomy (PELD) > standard open discectomy (SOD) > standard open microsurgical discectomy (SOMD) > chemonucleolysis (CN) > microendoscopic discectomy (MED) > percutaneous laser disc decompression (PLDD) > automated percutaneous lumber discectomy (APLD). For the complication rate the rank probability (from best to worst): PELD > SOMD > SOD > MED > PLDD > CN > APLD. For the reoperation rate the rank probability (from best to worst): SOMD > SOD > MED > PLDD > PELD > CN > APLD.
The limitations of this network meta-analysis include the range of study populations and inconformity of the follow-up times and outcome measurements.
This meta-analysis provides evidence that PELD might be the best choice to increase the success rate and decrease the complication rate, moreover SOMD might be the best option to drop the reoperation rate. APLD might lead to the lowest success rate and the highest complication and reoperation rate. Higher quality RCTs and direct head to head trials are needed to confirm these results.Key words: Lumbar disc herniation, discectomy, minimally invasive surgery, network meta-analysis.
椎间盘介入治疗的数量迅速增加，腰椎间盘手术的治疗选择也迅速发展。比较所有新创新手术与当前接受的治疗形式的安全性和有效性非常重要；然而，以前的成对荟萃分析无法确定这些治疗方法的优先级。
本研究旨在进行网络荟萃分析，以评估 7 种手术干预治疗腰椎间盘突出症的临床效果。
腰椎间盘突出症多治疗比较的随机对照试验（RCT）网络荟萃分析。
我们对 RCT 进行了贝叶斯框架网络荟萃分析，以比较 7 种治疗腰椎间盘突出症的手术干预措施。通过检索 Embase、Pubmed、Cochrane 中央对照试验注册中心（CENTRAL）和 Google Scholar，确定了合格的 RCT。由 2 名作者独立提取 3 个结局（成功率、并发症和再手术率）的数据。
共有 29 项 RCT 包括 3146 名参与者最终纳入本文。我们的荟萃分析为这 7 种干预措施提供了优先级。成功率方面，从最佳到最差的排名概率为：经皮内镜腰椎间盘切除术（PELD）>标准开放椎间盘切除术（SOD）>标准开放微创手术（SOMD）>化学核溶解术（CN）>经皮显微镜椎间盘切除术（MED）>经皮激光椎间盘减压术（PLDD）>自动经皮腰椎间盘切除术（APLD）。并发症发生率方面，从最佳到最差的排名概率为：PELD>SOMD>SOD>MED>PLDD>CN>APLD。再手术率方面，从最佳到最差的排名概率为：SOMD>SOD>MED>PLDD>PELD>CN>APLD。
本网络荟萃分析的局限性包括研究人群的范围以及随访时间和结局测量的不一致性。
本荟萃分析提供的证据表明，PELD 可能是提高成功率和降低并发症发生率的最佳选择，此外，SOMD 可能是降低再手术率的最佳选择。APLD 可能导致成功率最低，并发症和再手术率最高。需要更高质量的 RCT 和直接头对头试验来证实这些结果。关键词：腰椎间盘突出症，椎间盘切除术，微创手术，网络荟萃分析。
