Efficacy And Safety Of PELD For L5/S1 Disc Herniation Via Transforaminal Approach Versus Interlaminar Approach:A Meta-analysis Abstract

Objective: To systematically review the efficacy and safety of percutaneous endoscopic lumbar discectomy(PELD)for L5/S1 disc herniation via transforaminal approach(TF-PELD)versus interlaminar approach(ILPELD).Methods: PubMed,EMbase,The Cochrane Library,CBM,CNKI and WanFang Data databases were electronically searched to collect the randomized controlled trials(RCTs)and cohort studies of TF-PELD versus IL-PELD for L5/S1 disc herniation from inception to October 2017.Two reviewers independently screened literature,extracted data and assessed the risk of bias of included studies,then,meta-analysis was performed by using RevMan 5.3 software.Results: A total of 1 RCT and 7 cohort studies involving 414 patients were included.The results of meta-analysis indicated that: compared with IL-PELD group,TF-PELD group had longer operative time(MD=17.42,95%CI 12.86 to 21.97,P<0.00001)and the more frequency of intraoperative fluoroscopy(MD=8.42,95%CI 6.18 to 10.65,P<0.000 01),respectively.However,there was no significant difference between two groups in the post-operative visual analogue scale(MD=0.01,95%CI –0.23 to 0.25,P=0.94),the post-operative Oswestry disability index(MD=–0.46,95%CI –2.42 to 1.49,P=0.64),theexcellent and good outcomes rate(RR=1.00,95%CI 0.89 to 1.12,P=0.96),and the rate of complications(RR=0.73,95%CI 0.45 to 1.18,P=0.20).Conclusion: Current evidence shows that TF-PELD and IL-PELD are equally effective and safe for L5/S1 disc herniation,but IL-PELD is superior to TF-PELD in less operative time and less radiation exposure.Due to limited quality and quantity of the included studies,more high quality studies are needed to verify above conclusion.