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A meta-analysis of interlaminar minimally invasive discectomy compared to conventional microdiscectomy for lumbar
Xue-Song Wang1, Rui-Fu Sun1, Qiang Ji1
1Department of Spinal Surgery, Qingdao Central Hospital, Qingdao 266042, China.
Abstract:
A meta-analysis was conducted to evaluate the evidence that compared the safety and efficacy of interlaminar minimally invasive discectomy (ILMI) and conventional microdiscectomy (MD) for treating lumbar disk herniation (LDH) patients and to develop GRADE based recommendations for using the procedures to treat LDH. Eleven studies, encompassing 1012 patients, met the inclusion criteria. Overall, the results of the meta-analysis indicated that there were significant differences between the two groups in blood loss (SMD=-0.93, 95% CI -1.84, -0.02; p=0.05), and the number of days stays in hospital (SMD=-0.79, 95% CI -1.55, -0.04; p=0.04). However, there were no significant differences in the short-term back visual analog scale (VAS) scores (SMD=-0.34, 95% CI -0.81, 0.14; p=0.16), the long-term back VAS scores (SMD=0.13, 95% CI -0.04, 0.30; p=0.14), the short-term leg VAS scores (SMD=0.14, 95% CI -0.01, 0.29; p=0.07), the long-term leg VAS scores (SMD=0.12, 95% CI -0.05, 0.30; p=0.17), the short-term Oswestry disability index (ODI) scores (SMD=0.01, 95% CI -0.14, 0.15; p=0.92), the long-term ODI scores (SMD=0.11, 95% CI -0.03, 0.25; p=0.14), and the incidence of complications (RR=1.22, 95% CI 0.88, 1.69; p=0.24). The results of this meta-analysis demonstrate that ILMI and MD are both safe and effective surgical procedures for treating LDH. Compared with MD, ILMI can shorten days in hospital, decrease the mounts of blood loss during surgery. However, the overall GRADE evidence quality was very low. Therefore, further validation is required, and medical institutions should conduct high-quality studies.
Insights
Interlaminar minimally invasive discectomy (ILMI) and conventional microdiscectomy (MD) are safe and effective for lumbar disk herniation (LDH). ILMI shows reduced blood loss and shorter hospital stays, but evidence quality is low, requiring further high-quality studies for validation.
Area of Science:
- Neurosurgery
- Orthopedics
- Minimally Invasive Procedures
Background:
- Lumbar disk herniation (LDH) is a common condition requiring surgical intervention.
- Minimally invasive techniques aim to improve surgical outcomes and patient recovery.
- Interlaminar minimally invasive discectomy (ILMI) and conventional microdiscectomy (MD) are two surgical options for LDH.
Purpose of the Study:
- To compare the safety and efficacy of ILMI versus MD for treating LDH.
- To develop GRADE-based recommendations for the clinical application of ILMI and MD.
- To evaluate key surgical outcomes including blood loss, hospital stay, pain scores, disability, and complication rates.
Main Methods:
- A meta-analysis was performed on eleven studies including 1012 patients with LDH.
- Data on blood loss, hospital duration, Visual Analog Scale (VAS) pain scores, and Oswestry Disability Index (ODI) were extracted and analyzed.
- The incidence of complications and GRADE (Grading of Recommendations, Assessment, Development and Evaluations) evidence quality were assessed.
Main Results:
- ILMI was associated with significantly less blood loss (SMD=-0.93, p=0.05) and shorter hospital stays (SMD=-0.79, p=0.04) compared to MD.
- No significant differences were found between ILMI and MD in short-term or long-term back/leg pain (VAS scores) or disability (ODI scores).
- The overall incidence of complications did not differ significantly between the two surgical methods (RR=1.22, p=0.24), and the GRADE evidence quality was rated as very low.
Conclusions:
- Both ILMI and MD are safe and effective surgical treatments for LDH.
- ILMI offers potential advantages over MD by reducing blood loss and hospital stay duration.
- The very low GRADE evidence quality necessitates further high-quality research to validate these findings and guide clinical practice.
