Comparison of Efficacy and Safety between Percutaneous Transforaminal Endoscopic Discectomy and Tubular Microdiscectomy for Lumbar Disc Herniation: A Network Meta-Analysis

Abstract

Abstract Background Existing studies suggested that the efficacy and safety of tubular microdiscectomy (TMD) and percutaneous transforaminal endoscopic discectomy (TED) for lumbar disc herniation (LDH) was similar to open microdiscectomy (OMD). No head-to-head randomized controlled trials (RCTs) between TMD and TED for LDH have been reported, however, making room for indirect, integrated comparisons. Network meta-analysis (NMA) based on RCTs was used to comparing the clinical efficacy and safety of TMD and TED for LDH. Methods We systematically searched online databases of the Cochrane Library, PubMed, and Embase from inception through March 2023 for eligible literature. The following search terms were used: “transforaminal endoscopic discectomy,” “microdiscectomy,” “endoscopic,” “minimally invasive,” “tubular microdiscectomy,” “spinal disease,” and “randomized clinical trial”. Primary outcomes were Oswestry disability index (ODI), visual analogue scale (VAS) for leg pain, complications, and reoperation. Direct comparison meta-analyses and NMA were carried out. Results Eight RCTs (1391 patients) met the inclusion criteria. NMA indicated that there was no significant difference in any of the outcomes between TED and TMD. Trend analyses of rank probabilities showed that cumulative probabilities of being the most effective treatment, as measured by primary outcomes (VAS, ODI, reoperation, complications), were: TED (95%, 77%, 23%, 58%), TMD (4%, 22%, 54%, 36%), OMD (1%,1%, 23%, 6%). Conclusion This NMA showed no significant differences between TED and TMD in efficacy and safety for LDH. PROSPERO registration number: CRD42020156123.