Poster Presentation Sydney Spinal Symposium 2019

Complication rates of different discectomy techniques for the treatment of lumbar disc herniation (#27)

Xiaolong Chen 1 , Uphar Chamoli 1 , Sam Lapkin 2 , Jose Vargas Castillo 1 , Ashish Diwan 1
  1. Spine Service, St George & Sutherland Clinical School, University of New South Walse, UNSW Medicine, Sydney, NSW, Australia
  2. School of Nursing, Faculty of Science, Medicine and Health, University of Wollongong, South Western Sydney Campus, Sydney, NSW, Australia

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.