Meta-analysis Of Percutaneous Endoscopic Transforaminal Approach And Interlaminar Approach For The Treatment Of L5/S1 Disc Herniation

Objective Through meta-analysis of percutaneous endoscopic transforaminal approach and interlaminar approach for the treatment of L5/S1 disc herniationand and provide clinical guidance for most beginners.Method 1.According to the requisition of systematic evaluation,we formulate detailed standardization of the inclusion and exclusion criteria including the type of research subjects,population,interventions and outcome of events.2.An extensive search of literature was performed in CNKI,WANFANG DATA,MEDLINE,CocChrane Liburary?EMBASE and Pubmed,collection of relevant randomized or non-randomized controlled trials about the meta analysis of percutaneous endoscopic transforaminal approach and interlaminar approach for the treatment of L5/S1 disc herniation.According to the inclusion and exclusion criteria,quality evaluation and heterogeneity analysis are carried out for the retrieved literatures.Then,using the RevMan5.3 system evaluation software provided by the collaborative network,the paper is analyzed in accordance with the requirements.Finally draw the conclusion.Results In this systematic review,8 articles were included in the literature,a total of 492 cases of observation objects,including 244 cases of PETD group and 248 cases of PEID group.Meta-analysis showed that: 1.Seven studies conducted PETD and PEID treatment of L5/S1 disc herniation preoperative VAS score of the comparative study,the results showed: There were no significant differences in the scores [subgroup of low back pain: WMD=-0.42(-1.40,0.56),P=0.40;subgroups of leg pain: WMD = 0.10(-1.39,1.59),P=0.89;subgroups of low back and leg pain: WMD=0.04(-0.39,0.48),P=0.85;total effect WMD=-0.15(-0.45,0.15),P=0.33].2.Seven studies conducted PETD treatment of L5/S1 disc herniation preoperative and postoperative VAS score of the comparative study,the results showed: PETD treatment of L5/S1 intervertebral disc herniation of postoperative VAS score significantly lower than the preoperative VAS score,the difference was statistically significant [subgroup of low back pain: WMD=2.04(1.81,2.26),P<0.01;subgroups of leg pain: WMD=6.41(5.94,6.88)P<0.01;subgroups of low back and leg pain: WMD=5.21(4.08,6.34),P<0.01,P<0.01;total effect WMD=4.75(3.18,6.31),P<0.01].3.Seven studies conducted PEID treatment of L5/S1 disc herniation preoperative and postoperative VAS score of the comparative study,the results showed: PEID treatment of L5/S1 intervertebral disc herniation of postoperative VAS score significantly lower than the preoperative VAS score,the difference was statistically significant [subgroup of low back pain: WMD=2.30(1.68,2.91),P<0.01;subgroups of leg pain: WMD=6.22(5.32,7.12)P<0.01;subgroups of low back and leg pain: WMD=5.23(3.80,6.66),P<0.01;total effect WMD=4.80(3.21,6.40),P<0.01].4.Seven studies conducted PETD and PEID treatment of L5/S1 disc herniation postoperative VAS score of the comparative study,the results showed: There were no significant differences in the scores in the subgroup of low back pain: [WMD=-0.01(-0.21,0.18),P=0.89];the postoperative VAS score difference was statistically significant in the subgroups of leg pain: [WMD=-0.22(-0.43,-0.02),P=0.03];There were no significant differences in the scores in the subgroup of low back and leg pain: [WMD=0.06(-0.20,0.31),P=0.65];total effect [WMD=-0.07(-0.20,0.05),P=0.24].5.Seven studies conducted PETD and PEID treatment of L5/S1 disc herniation fluoroscopy time of the comparative study,the results showed: the fluoroscopy time in group PEID were significantly less than those in group PETD,the difference was statistically significant [SMD=3.12(2.34,3.90),P<0.01].6.Seven studies conducted PETD and PEID treatment of L5/S1 disc herniation Operation time of the comparative study,the results showed: PEID group had less operation time than PETD group,the difference was statistically significant [WMD=11.45(4.72,18.18),P<0.01].7.Five studies conducted PETD and PEID treatment of L5/S1 disc herniation excellence/good rate of the comparative study,the results showed: There were no significant differences in the excellence/good rate difference [OR=0.96(0.43,2.11),P=0.92].8.Four studies conducted PETD and PEID treatment of L5/S1 disc herniation preoperative ODI scores of the comparative study.The results showed that: There was no significant difference in preoperative ODI scores between the transforaminal approach and the interlaminar approach in the treatment of L5/S1 disc herniation [WMD=0.53(-3.16,4.21),P=0.78].9.Four studies conducted PETD and PEID treatment of L5/S1 disc herniation postoperative ODI scores of the comparative study.The results showed that: There was no significant difference in postoperative ODI scores between the transforaminal approach and the interlaminar approach in the treatment of L5/S1 disc herniation [WMD=-0.22(-2.28,1.83),P=0.83].10.Eight studies conducted PETD and PEID treatment of L5/S1 disc herniation postoperative complication rate of the comparative study.The results showed that: There was no significant difference in postoperative complication rate between the transforaminal approach and the interlaminar approach in the treatment of L5/S1 disc herniation [RD=-0.03(-0.06,0.01),P=0.10].Conclusion There was no significant difference in curative effect,excellent/good rate and complication rate between transforaminal approach and interlaminar approach in the treatment of L5/S1 disc herniation,but the operation time and fluoroscopic times of interlaminar approach were less than transforaminal approach,interlaminar approaches are more easier and faster.