Comparison Of Clinical Efficacy Between PTED And Open Surgery Under Microscope In The Treatment Of Lumbar Spinal Stenosis: Systematic Review And Meta-analysis

Objective: To systematically assess the clinical effects of Percutaneous Transforaminal Endoscopic Discectomy(PTED)and surgery under microscope in the treatment of Lumbar spinal stenosis(LSS).Methods:1.Data source: The following databases were searched for Randomized controlled trials(RCT): The Cochrane Library,Embase,Medline and CNKI.At the same time,we searched literature from The Google Scholar.The search was performed in February 2021.We also recorded the reference list of all chosen papers.2.Inclusion criteria: Randomized controlled trials that directly compared any type of Percutaneous Transforaminal Endoscopic Discectomy(PTED)and surgery under microscope in the treatment of LSS(lumbar spinal stenosis)with at least 3 months’ follow-up were chosen.Primary outcome was Oswestry disability index(ODI),secondary outcomes included VAS(visual analogue scale),intraoperative blood loss,operative time.3.Assessment of RCTs and data analysis: Literature screening and data collection were performed according to The Cochrane Handbook for Systematic Reviews of Interventions.Risk of bias was performed using the bias risk assessment tool for RCT.We used mean differences(MDs)for the outcomes,and calculated 95% confidence intervals(CIs)for each outcome.Assessment of heterogeneity was conducted and if heterogeneity existed,we used random effect model to deal with it.We used funnel plot to assess reporting biases.Results:1.6 literatures containing 6 RCTs were included;2.Bias risk assessment showed that there was no fatal defect among the RCTs,but blinding was not implemented;3.ODI(Oswestry disability index): There didn’t exist statistically difference between PTED and surgery performed under microscope at 3months(P>0.05,MD:-2.07;95% CI-4.46 to 0.31);VAS(visual analogue scale): There was a statistically difference between PTED and surgery performed under microscope at 3 months,which was in favour of the PTED group(P<0.05,MD:-0.58;95% CI-0.91 to-0.25).Operative time: there didn’t exist statistically difference between PTED and surgery performed under microscope(P>0.05,MD:3.30;95% CI-8.63 to 15.23);Intraoperative blood loss: There was a statistically difference between PTED and surgery performed under microscope,which was in favour of PTED group(P<0.05,MD:-58.4;95% CI-92.22 to-24.57);4.There was low possibility of reporting bias.Conclusions:1.ODI score shows that there doesn’t exist statistical difference between two methods while VAS score shows that PTED group has statistical superiority.The difference between the two methods may have no practical importance.2.There is no statistical difference in the operative time between the PTED group and the surgery under microscope group.The PTED group is statistically superior to the microscope group in terms of intraoperative blood loss.3.Both PTED and surgery under microscope are clinically significant interventions for the treatment of lumbar spinal stenosis.