Purpose: The aim of this network meta-analysis (NMA) is to compare the complication rates of discectomy/microdiscectomy, percutaneous laser disc decompression (PLDD), percutaneous endoscopic lumbar discectomy (PELD), microendoscopic discectomy (MED), and tubular discectomy for symptomatic lumbar disc herniation (LDH).
Methods: We searched three online databasesfor randomized controlled trials (RCTs).Overall complication rates, complication rates per general and modified Clavien-Dindo classification schemes, and reoperation rates were considered as primary outcomes. Odd ratio with 95% confidence intervals for direct comparisons and 95% credible intervals for NMA results were reported. Surface under cumulative ranking curve (SUCRA) was used to estimate ranks for each discectomy technique based on the complication rates.
Results: In total, 18 RCTs with 2273 patients were included in this study. Our results showed that therewas no significant difference in any of the pairwise comparisons. PELD (SUCRA: 0.856) ranked the lowest for overall complication rates. Discectomy/microdiscectomy (SUCRA: 0.599) and PELD (SUCRA: 0.939) ranked the lowest for intraoperative and post-operative complication rates, respectively. Concerning modified Clavien-Dindo classification scheme, PELD (SUCRA: 0.803), MED (SUCRA: 0.730), and PLDD (SUCRA: 0.605) ranked the lowest for the occurrence of type I, II, and III complications, respectively. Tubular discectomy (SUCRA: 0.699) ranked the lowest for reoperation rates.
Conclusions: The results of this NMA suggest that discectomy/microdiscectomyand PELD are the safest procedures for LDH with minimal post-operative and intraoperative complication rates. PELD, MED and PLDD are the safest procedures for LDH in terms of minimal rates for complications necessitating conservative,pharmacological, and surgical treatment, respectively.