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J Neurol Surg A Cent Eur Neurosurg
DOI: 10.1055/a-2053-8365
Original Article

Comparison of Full Endoscopic Lumbar Diskectomy Using the Transforaminal Approach versus Interlaminar Approach for L5–S1 Lumbar Disk Herniation Treatment: A Meta-Analysis

Ming-Tao Zhu   *
1   Department of Neurosurgery, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, People's Republic of China
,
Bao-Shan Hu   *
2   Department of Orthopedics, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, People's Republic of China
3   The Third Clinical Medical College, The School of Clinical Medicine, Fujian Medical University, Fuzhou, Fujian, People's Republic of China
,
Chien-Min Chen   *
4   Division of Neurosurgery, Department of Surgery, Changhua Christian Hospital, Changhua, Taiwan
5   Department of Leisure Industry Management, National Chin-Yi University of Technology, Taichung, Taiwan
,
Hong-Qi Liu
6   Department of Orthopedics, Zhangpu Country Hospital, Zhangzhou, People's Republic of China
3   The Third Clinical Medical College, The School of Clinical Medicine, Fujian Medical University, Fuzhou, Fujian, People's Republic of China
,
Guang-Xun Lin
2   Department of Orthopedics, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, People's Republic of China
3   The Third Clinical Medical College, The School of Clinical Medicine, Fujian Medical University, Fuzhou, Fujian, People's Republic of China
› Author Affiliations Funding This research was funded by the “Natural Science Foundation of Fujian Province, grant number 2021J05282 ”; funded by Xiamen Municipal Bureau of Science and Technology (3502Z20224033); funded by the “Xiamen Health System Discipline Leaders and their Backup Candi-dates, Senior Management Talent Training Candidates Training Program (2021) ”; funded by the “Ningxia Jingyuan County Science and Technology Planning Bureau (2022) ”. The funder had no role in the design of the study or collection, analysis, or interpretation of data or in writing the manuscript.
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Abstract

Background Numerous studies have examined the clinical effectiveness of transforaminal full endoscopic lumbar diskectomy (T-FELD) and interlaminar full endoscopic lumbar diskectomy (I-FELD) for L5–S1 lumbar disk herniation (LDH), with mixed findings. The goal of this systematic review and meta-analysis was to evaluate the perioperative outcomes, clinical results, and complications of T-FELD and I-FELD to determine their efficacy and safety for treating L5–S1 LDH and to examine the features of complications in depth.

Methods Several databases were searched for articles that matched all of the inclusion criteria. The visual analog scale (VAS) and Oswestry Disability Index (ODI) were used to assess the clinical results. Information on perioperative outcomes and complications was gathered and analyzed.

Results Eight studies with 756 participants were included. There were no significant differences in postoperative bed time (p = 0.44) and hospitalization time (p = 0.49) between T-FELD and I-FELD. When compared with I-FELD, T-FELD was associated with substantially longer fluoroscopy time (p < 0.0001) and operating time (p < 0.0001). There were no significant differences in the preoperative and postoperative VAS and ODI scores between T-FELD and I-FELD. The rates for overall complications, postoperative dysesthesia, postoperative lower extremity pain, incomplete decompression, recurrence, and conversion to open surgery were comparable for T-FLED and I-FELD.

Conclusion T-FELD and I-FELD had equal clinical results and safety for treatment of L5–S1 LDH. Fluoroscopy and operative times were shorter for I-FELD than for T-FELD.

Keywords

full endoscopic lumbar diskectomy - transforaminal - interlaminar - L5–S1 - lumbar disk herniation

* These authors have contributed equally to this work.




Publication History

Received: 04 May 2022

Accepted: 07 March 2023

Accepted Manuscript online:
14 March 2023

Article published online:
24 August 2023

© 2023. Thieme. All rights reserved.

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  • References

  • 1 Hua W, Ke W, Wang B. et al. Comparison of the clinical outcomes of full-endoscopic visualized foraminoplasty and discectomy versus microdiscectomy for lumbar disc herniation. Orthop Surg 2022; 14 (02) 280-289
    CrossrefPubMedGoogle Scholar
  • 2 Aiyer R, Noori S, Schirripa F. et al. A systematic review of full endoscopic versus micro-endoscopic or open discectomy for lumbar disc herniation. Pain Manag (Lond) 2022; 12 (01) 87-104
    CrossrefPubMedGoogle Scholar
  • 3 Gadjradj PS, Smeele NVR, de Jong M. et al. Patient preferences for treatment of lumbar disc herniation: a discrete choice experiment. J Neurosurg Spine 2021; 36 (05) 704-712
    CrossrefPubMedGoogle Scholar
  • 4 Jarebi M, Awaf A, Lefranc M, Peltier J. A matched comparison of outcomes between percutaneous endoscopic lumbar discectomy and open lumbar microdiscectomy for the treatment of lumbar disc herniation: a 2-year retrospective cohort study. Spine J 2021; 21 (01) 114-121
    CrossrefPubMedGoogle Scholar
  • 5 Lin GX, Park CW, Suen TK, Kotheeranurak V, Jun SG, Kim JS. Full endoscopic technique for high-grade up-migrated lumbar disk herniation via a translaminar keyhole approach: preliminary series and technical note. J Neurol Surg A Cent Eur Neurosurg 2020; 81 (05) 379-386
    Article in Thieme ConnectPubMedGoogle Scholar
  • 6 Huang Y, Yin J, Sun Z. et al. Percutaneous endoscopic lumbar discectomy for LDH via a transforaminal approach versus an interlaminar approach: a meta-analysis. Orthopade 2020; 49 (04) 338-349
    CrossrefPubMedGoogle Scholar
  • 7 Chen P, Hu Y, Li Z. Percutaneous endoscopic transforaminal discectomy precedes interlaminar discectomy in the efficacy and safety for lumbar disc herniation. Biosci Rep 2019; 39 (02) BSR20181866
    CrossrefPubMedGoogle Scholar
  • 8 Chen KT, Wei ST, Tseng C, Ou SW, Sun LW, Chen CM. Transforaminal endoscopic lumbar discectomy for L5-S1 disc herniation with high iliac crest: technical note and preliminary series. Neurospine 2020; 17 (Suppl. 01) S81-S87
    CrossrefPubMedGoogle Scholar
  • 9 Song QC, Zhao Y, Li D. et al. Percutaneous endoscopic transforaminal discectomy for the treatment of L5-S1 lumbar disc herniation and the influence of iliac crest height on its clinical effects. Exp Ther Med 2021; 22 (02) 866
    CrossrefPubMedGoogle Scholar
  • 10 Nie H, Zeng J, Song Y. et al. Percutaneous endoscopic lumbar discectomy for L5-S1 disc herniation via an interlaminar approach versus a transforaminal approach: a prospective randomized controlled study with 2-year follow up. Spine 2016; 41 (Suppl. 19) B30-B37
    CrossrefPubMedGoogle Scholar
  • 11 Choi KC, Kim JS, Ryu KS, Kang BU, Ahn Y, Lee SH. Percutaneous endoscopic lumbar discectomy for L5-S1 disc herniation: transforaminal versus interlaminar approach. Pain Physician 2013; 16 (06) 547-556
    PubMedGoogle Scholar
  • 12 Moher D, Shamseer L, Clarke M. et al; PRISMA-P Group. Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Syst Rev 2015; 4 (01) 1
    CrossrefPubMedGoogle Scholar
  • 13 Gao A, Yang H, Zhu L. et al. Comparison of interlaminar and transforaminal approaches for treatment of L5/S1 disc herniation by percutaneous endoscopic discectomy. Orthop Surg 2021; 13 (01) 63-70
    CrossrefPubMedGoogle Scholar
  • 14 Wei H, Shunli K, Zehua J, Tengfei Z, Yidong L, Rusen Z. Comparative study of three minimally invasive surgical approaches for the treatment of L5/S1 lumbar intervertebral disc herniation. Turk Neurosurg 2021; 31 (03) 324-332
    PubMedGoogle Scholar
  • 15 Hua W, Zhang Y, Wu X. et al. Outcomes of discectomy by using full-endoscopic visualization technique via the interlaminar and transforaminal approaches in the treatment of L5-S1 disc herniation: an observational study. Medicine (Baltimore) 2018; 97 (48) e13456
    CrossrefPubMedGoogle Scholar
  • 16 Mo X, Shen J, Jiang W. et al. Percutaneous endoscopic lumbar diskectomy for axillar herniation at L5-S1 via the transforaminal approach versus the interlaminar approach: a prospective clinical trial. World Neurosurg 2019; 125: e508-e514
    CrossrefPubMedGoogle Scholar
  • 17 Wang D, Xie W, Cao W, He S, Fan G, Zhang H. A cost-utility analysis of percutaneous endoscopic lumbar discectomy for L5-S1 lumbar disc herniation: transforaminal versus interlaminar. Spine 2019; 44 (08) 563-570
    CrossrefPubMedGoogle Scholar
  • 18 Yan Y, Zhu M, Cao X. et al. Different approaches to percutaneous endoscopic lumbar discectomy for L5/S1 lumbar disc herniation: a retrospective study. Br J Neurosurg 2020; 1-7
    CrossrefPubMedGoogle Scholar
  • 19 Gasenzer ER, Kanat A, Ozdemir V, Neugebauer E. Analyzing of dark past and bright present of neurosurgical history with a picture of musicians. Br J Neurosurg 2018; 32 (03) 303-304
    CrossrefPubMedGoogle Scholar
  • 20 Kanat A, Epstein CR. Challenges to neurosurgical professionalism. Clin Neurol Neurosurg 2010; 112 (10) 839-843
    CrossrefPubMedGoogle Scholar
  • 21 Kanat A, Yazar U, Kazdal H, Sonmez OF. Introducing a new risk factor for lumbar disc herniation in females : vertical angle of the sacral curvature. J Korean Neurosurg Soc 2012; 52 (05) 447-451
    CrossrefPubMedGoogle Scholar
  • 22 Pan M, Li Q, Li S. et al. Percutaneous endoscopic lumbar discectomy: indications and complications. Pain Physician 2020; 23 (01) 49-56
    PubMedGoogle Scholar
  • 23 Liu X, Yuan S, Tian Y. et al. Comparison of percutaneous endoscopic transforaminal discectomy, microendoscopic discectomy, and microdiscectomy for symptomatic lumbar disc herniation: minimum 2-year follow-up results. J Neurosurg Spine 2018; 28 (03) 317-325
    CrossrefPubMedGoogle Scholar
  • 24 Wang D, Fan G, Yin B. et al. Surgically relevant morphological parameters of the L5-S1 interlaminar window: a statistical analysis based on 3D reconstruction of CT data. J Neurol Surg A Cent Eur Neurosurg 2021; (e-pub ahead of print). DOI: 10.1055/a-1698-6384.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 25 Hung SF, Liao JC, Tsai TT. et al. Comparison of outcomes between indirect decompression of oblique lumbar interbody fusion and MIS-TLIF in one single-level lumbar spondylosis. Sci Rep 2021; 11 (01) 12783
    CrossrefPubMedGoogle Scholar
  • 26 Wu K, Zhao Y, Feng Z, Hu X, Chen Z, Wang Y. Stepwise local anesthesia for percutaneous endoscopic interlaminar discectomy: technique strategy and clinical outcomes. World Neurosurg 2020; 134: e346-e352
    CrossrefPubMedGoogle Scholar
  • 27 Eun SS, Chachan S, Lee SH. Interlaminar percutaneous endoscopic lumbar discectomy: rotate and retract technique. World Neurosurg 2018; 118: 188-192
    CrossrefPubMedGoogle Scholar
  • 28 Yoshikane K, Kikuchi K, Okazaki K. Posterolateral transforaminal full-endoscopic lumbar discectomy for foraminal or extraforaminal lumbar disc herniations. World Neurosurg 2021; 146: e1278-e1286
    CrossrefPubMedGoogle Scholar
  • 29 Sairyo K, Chikawa T, Nagamachi A. State-of-the-art transforaminal percutaneous endoscopic lumbar surgery under local anesthesia: discectomy, foraminoplasty, and ventral facetectomy. J Orthop Sci 2018; 23 (02) 229-236
    CrossrefPubMedGoogle Scholar
  • 30 Kim HS, Paudel B, Jang JS, Lee K, Oh SH, Jang IT. Percutaneous endoscopic lumbar discectomy for all types of lumbar disc herniations (LDH) including severely difficult and extremely difficult LDH cases. Pain Physician 2018; 21 (04) E401-E408
    PubMedGoogle Scholar