Systematic review of microendoscopic discectomy for lumbar disc herniation

Study design Systematic review. Objective To search and analyse randomised controlled trials (RCTs) published since the Cochrane review by Gibson and Waddell (2007) comparing microendoscopic discectomy (MED) with open discectomy (OD) or microdiscectomy (MD) and to assess whether MED improves patient...

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Bibliographic Details
Published in:European spine journal 2013-11, Vol.22 (11), p.2458-2465
Main Authors: Smith, Nick, Masters, James, Jensen, Cyrus, Khan, Almas, Sprowson, Andrew
Format: Article
Language:English
Subjects:
Diskectomy - methods
Endoscopy
Humans
Intervertebral Disc Displacement - complications
Intervertebral Disc Displacement - surgery
Lumbar Vertebrae - surgery
Medicine
Medicine & Public Health
Microsurgery
Neurosurgery
Randomized Controlled Trials as Topic
Review
Review Article
Sciatica - etiology
Sciatica - surgery
Surgical Orthopedics
Treatment Outcome
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Summary:Study design Systematic review. Objective To search and analyse randomised controlled trials (RCTs) published since the Cochrane review by Gibson and Waddell (2007) comparing microendoscopic discectomy (MED) with open discectomy (OD) or microdiscectomy (MD) and to assess whether MED improves patient-reported outcomes. Summary of background Discectomy for symptomatic herniated lumbar discs is an effective operative treatment. A number of operative techniques exist including OD, MD, and MED. A 2007 Cochrane review identified OD as an effective treatment for symptom improvement, and found sufficient evidence for MD. However, evidence for MED was lacking. Methods A systematic review of Medline and Embase was carried out. Aiming to identify RCTs carried out after 2007, which compared OD with MD and MED which reported the Oswestry disability index (ODI) as an outcome. Results Four RCTs were identified. None of the studies found a significant difference in the ODI scores between study groups at any time point. Three studies compared MED to OD and one compared OD, MD, and MED. The largest study reported an increased number of severe complications in the MED group. Conclusions There is some evidence to suggest that MED performed by surgeons skilled in the technique in tertiary referral centres is as effective as OD.
ISSN:0940-6719
1432-0932
DOI:10.1007/s00586-013-2848-8