Echt Murray, Holland Ryan, Mowrey Wenzhu, Cezayirli Phillip, De la Garza Ramos Rafael, Hamad Mousa, Gelfand Yaroslav, Longo Michael, Kinon Merritt D, Yanamadala Vijay, Chaudhary Saad, Cho Samuel K, Yassari Reza
2013Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA.
5925Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Global Spine J. 2021 Jun;11(5):802-813. doi: 10.1177/2192568220941815. Epub 2020 Aug 3.
Systematic review and meta-analysis.
To conduct a literature review on outcomes of discectomy for upper lumbar disc herniations (ULDH), estimate pooled rates of satisfactory outcomes, compare open laminectomy/microdiscectomy (OLM) versus minimally invasive surgical (MIS) techniques, and compare results of disc herniations at L1-3 versus L3-4.
A systematic review of articles reporting outcomes of nonfusion surgical treatment of L1-2, L2-3, and/or L3-4 disc herniations was performed. The inclusion and exclusion of studies was performed according to the latest version of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement.
A total of 20 articles were included in the quantitative meta-analysis. Pooled proportion of satisfactory outcome (95% CI) was 0.77 (0.70, 0.83) for MIS and 0.82 (0.78, 0.84) for OLM. There was no significant improvement with MIS techniques compared with standard OLM, odds ratio (OR) = 0.86, 95% CI (0.42, 1.74), = .66. Separating results by levels revealed a trend of higher satisfaction with L3-4 versus L1-3 with OLM surgery, OR = 0.46, 95% CI (0.19, 1.12), = .08.
Our analysis reveals that discectomy for ULDH has an overall success rate of approximately 80% and has not improved with MIS. Discectomy for herniations at L3-4 trends toward better outcomes compared with L1-2 and L2-3, but was not significant.
系统评价与荟萃分析。
对上位腰椎间盘突出症（ULDH）椎间盘切除术的结果进行文献综述，估计满意结果的合并率，比较开放椎板切除术/显微椎间盘切除术（OLM）与微创手术（MIS）技术，并比较L1 - 3与L3 - 4椎间盘突出症的结果。
对报告L1 - 2、L2 - 3和/或L3 - 4椎间盘突出症非融合手术治疗结果的文章进行系统评价。根据系统评价和荟萃分析的首选报告项目（PRISMA）声明的最新版本进行研究的纳入和排除。
共有20篇文章纳入定量荟萃分析。MIS的满意结果合并比例（95%可信区间）为0.77（0.70，0.83），OLM为0.82（0.78，0.84）。与标准OLM相比，MIS技术没有显著改善，优势比（OR） = 0.86，95%可信区间（0.42，1.74），P = 0.66。按节段分层分析结果显示，对于OLM手术，L3 - 4节段的满意度高于L1 - 3节段，OR = 0.46，95%可信区间（0.19，1.12），P = 0.08。
我们的分析表明，ULDH椎间盘切除术的总体成功率约为80%，且MIS技术并未使其得到改善。与L1 - 2和L2 - 3相比，L3 - 4节段椎间盘突出症的椎间盘切除术预后有更好的趋势，但差异不显著。
