Department of Neurosurgery, Leiden University Medical Center, University Neurosurgical Center Holland (UNCH), Leiden, the Netherlands.
Department of Neurosurgery, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands.
Spine (Phila Pa 1976). 2021 Apr 15;46(8):538-549. doi: 10.1097/BRS.0000000000003843.
Systematic review and meta-analysis.
To give a systematic overview of effectiveness of percutaneous transforaminal endoscopic discectomy (PTED) compared with open microdiscectomy (OM) in the treatment of lumbar disk herniation (LDH).
The current standard procedure for the treatment of sciatica caused by LDH, is OM. PTED is an alternative surgical technique which is thought to be less invasive. It is unclear if PTED has comparable outcomes compared with OM.
Multiple online databases were systematically searched up to April 2020 for randomized controlled trials and prospective studies comparing PTED with OM for LDH. Primary outcomes were leg pain and functional status. Pooled effect estimates were calculated for the primary outcomes only and presented as standard mean differences (SMD) with their 95% confidence intervals (CI) at short (1-day postoperative), intermediate (3-6 months), and long-term (12 months).
We identified 2276 citations, of which eventually 14 studies were included. There was substantial heterogeneity in effects on leg pain at short term. There is moderate quality evidence suggesting no difference in leg pain at intermediate (SMD 0.05, 95% CI -0.10-0.21) and long-term follow-up (SMD 0.11, 95% CI -0.30-0.53). Only one study measured functional status at short-term and reported no differences. There is moderate quality evidence suggesting no difference in functional status at intermediate (SMD -0.09, 95% CI -0.24-0.07) and long-term (SMD -0.11, 95% CI -0.45-0.24).
There is moderate quality evidence suggesting no difference in leg pain or functional status at intermediate and long-term follow-up between PTED and OM in the treatment of LDH. High quality, robust studies reporting on clinical outcomes and cost-effectiveness on the long term are lacking.Level of Evidence: 2.
系统评价和荟萃分析。
系统综述经皮椎间孔内窥镜椎间盘切除术（PTED）与开放显微椎间盘切除术（OM）治疗腰椎间盘突出症（LDH）的疗效。
目前治疗坐骨神经痛的标准方法是 OM。PTED 是一种替代的手术技术，被认为是一种微创技术。目前尚不清楚 PTED 是否与 OM 具有可比的结果。
系统检索了多个在线数据库，检索时间截至 2020 年 4 月，以寻找比较 PTED 与 OM 治疗 LDH 的随机对照试验和前瞻性研究。主要结局是腿痛和功能状态。仅对主要结局进行汇总效应估计，并以标准均数差值（SMD）及其 95%置信区间（CI）表示，随访时间分别为短期（术后 1 天）、中期（3-6 个月）和长期（12 个月）。
共检索到 2276 条引文，最终纳入 14 项研究。短期腿痛的效果存在显著异质性。有中等质量的证据表明，在中期（SMD 0.05，95%CI -0.10-0.21）和长期随访（SMD 0.11，95%CI -0.30-0.53）时，腿痛无差异。只有一项研究在短期测量了功能状态，报告无差异。有中等质量的证据表明，在中期（SMD -0.09，95%CI -0.24-0.07）和长期（SMD -0.11，95%CI -0.45-0.24）时，功能状态无差异。
在治疗 LDH 方面，PTED 与 OM 相比，在中期和长期随访时，腿痛或功能状态无差异。目前缺乏高质量、稳健的研究报告长期的临床结果和成本效益。
2 级。
