Sciatica is usually defined as pain in the lower extremities caused by compression or irritation of the lumbosacral nerve. When conservative treatment is ineffective or the patient’s symptoms worsen, the compressed disc can be surgically removed to relieve the nerve root compression. The use of minimally invasive surgery (interlaminar approach and foraminoscopic approach) is currently becoming more and more popular. However, the safety of minimally invasive surgery has been questioned due to its small working access and poor visibility.
However, conventional surgery has its own drawbacks, such as long incisions and substantial muscle trauma. In order to clarify the clinical significance and cost difference between minimally invasive and conventional surgery, Australian academic KamperSJ et al. conducted a Meta-analysis summarizing studies up to January 2013, which was published in the recent issue of EurSpine.
MEDLINE,EMBASE, and the Cochrane Library were searched according to the established search protocol, and 29 relevant studies (16 randomized controlled trials, 4 prospective cohort studies, and 9 retrospective cohort studies) were finally included according to the established inclusion and exclusion criteria, and the included sample was 4472 individuals. And, the authors performed a treatment evaluation of the study results (GRADE method).
The results of this study showed no significant difference in clinical outcomes between minimally invasive surgery and conventional surgery for lumbar disc herniation. However, the interlaminar approach was 11 minutes longer, with 52 ml less bleeding and 1.5 days shorter hospital stay. There was no difference between minimally invasive interlaminar approach surgery and conventional surgery in terms of complications and in the rate of surgery. However, studies comparing interlaminar approach surgery with conventional surgery have the following drawbacks such as high risk of bias, small included studies and small samples.
The disadvantages of this study are as follows: 1. The included randomized controlled studies were mostly small samples, especially the lack of high-quality, accurate clinical outcomes of studies comparing interlaminar approach surgery with conventional surgery, which leads to a lack of strength of the findings, and 2. Studies on the social benefits associated with minimally invasive surgery with shorter hospitalization days and early return to work for patients are also lacking.
The results of this study showed that interlaminar approach minimally invasive surgery for lumbar disc herniation did not differ from conventional surgery in terms of clinical outcomes and perioperative costs. In contrast, the clinical differences between minimally invasive interlaminar approach and conventional surgery cannot be concluded due to the limitations of the study sample.