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Lumbar Spine Surgery: Causes, Complications and Management

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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Orthopedics".

Deadline for manuscript submissions: closed (29 May 2023) | Viewed by 21407

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Special Issue Editors

Dr. Shoji Seki

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Guest Editor

Department of Orthopedic Surgery, Faculty of Medicine, University of Toyama, Toyama 930-0194, Japan
Interests: intervertebral disc; spinal deformity; degenerative lumbar scoliosis
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Dr. Koji Akeda

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Guest Editor

Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, Mie 514-8507, Japan
Interests: adult spinal deformity; lateral lumbar interbody fusion (LLIF); minimally invasive spinal treatment (MIST); degenerative disc diseases; intervertebral disc therapy
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Dr. Takashi Kaito

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Guest Editor

Department of Orthopedic Surgery, Osaka University Graduate School of Medicine, Osaka 565-0871, Japan
Interests: spinal cord; spinal fusion; spine; cervical spine; bone regeneration
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Dr. Tetsuro Ohba

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Guest Editor

Department of Orthopaedic Surgery, Faculty of Medicine, University of Yamanashi, Yamanashi 409-3898, Japan
Interests: spine surgery; minimally invasive spine surgery
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Lumbar spinal disorders are common and lead to substantial morbidity and loss of productivity in society. In recent years, diagnostic imaging of the lumbar spine has made great strides, such as with improvements in tractgraphy, CT/MRI fusion imaging, and whole-body bone X-ray. It is thought that advances in these spinal diagnostic imaging techniques will lead to further advances in their causes and treatment methods. Recently, fields such as computer-assisted surgery and diagnostic imaging using AI (artificial intelligence) seem to be fields that are expected to develop further in the future. Further research is desirable to establish breakthrough discoveries and treatments for lumbar spinal disorders.

In this Special Issue, we invite submissions that focus on lumbar spinal scoliosis, the pathophysiology and treatment of intervertebral disc diseases and minimally invasive lumbar spinal surgery. Submissions can be in the form of literature reviews providing insight into the current knowledge and technical know-how, as well as original research that addresses key questions in spinal care. Spinal disorders are diverse in their presentation, treatment and outcomes; thus, any submission relating to spinal disorders will be considered.

We look forward to receiving your submission.

Dr. Shoji Seki
Dr. Koji Akeda
Dr. Takashi Kaito
Dr. Tetsuro Ohba
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

management of lumbar scoliosis
basic science of lumbar spinal disorder
causes of lumbar disc herniation
treatment of intervertebral disc diseases
minimally invasive surgery
fusion or decompression
management of complications
how to avoid complications
computer-assisted lumbar spinal surgery

Published Papers (12 papers)

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Editorial

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3 pages, 182 KiB

Open AccessEditorial

What Types of Strategies Are Effective in Lumbar Spine Surgery? Considering the Etiology, Imaging Findings, and Risk of Complications

by Shoji Seki, Koji Akeda, Takashi Kaito and Tetsuro Ohba

J. Clin. Med. 2023, 12(13), 4443; https://doi.org/10.3390/jcm12134443 - 01 Jul 2023

Viewed by 764

Abstract

Lumbar spine surgery is commonly performed worldwide for the treatment of lumbar spinal disorder, and the surgery saves many patients with lower back and lower extremity pain [...] Full article

(This article belongs to the Special Issue Lumbar Spine Surgery: Causes, Complications and Management)

Research

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9 pages, 1665 KiB

Open AccessArticle

Anatomical Analysis of the Gonadal Veins and Spine in Lateral Lumbar Interbody Fusion

by Yujiro Kagami, Hiroaki Nakashima, Kotaro Satake, Kenyu Ito, Mikito Tsushima, Naoki Segi, Hiroyuki Tomita, Jun Ouchida, Yoshinori Morita, Yukihito Ode, Shiro Imagama and Tokumi Kanemura

J. Clin. Med. 2023, 12(8), 3041; https://doi.org/10.3390/jcm12083041 - 21 Apr 2023

Cited by 1 | Viewed by 861

Abstract

Background: The current study aimed to investigate the anatomical position of the gonadal veins (GVs) from the viewpoint of spine surgery and the risk factors associated with lateral lumbar interbody fusion (LLIF). Methods: This retrospective study included 99 consecutive patients. The GV locations were divided into the ventral (V), dorsal medial (DM), and dorsal lateral (DL) sides based on lumbar disk levels on axial contrast-enhanced computed tomography images. The DM region surrounded by the vertebral body and psoas muscle had the highest risk of GV injury. The GV at each intervertebral disk level was examined in terms of laterality and sex. The patients were divided into group M (which included those with GV in the DM region at any vertebral level) and group O (which included those without GV in the DM region at any vertebral level). Then, the two groups were compared. Results: In the case of lower lumbar levels and in women, the GVs were commonly observed in the DM region. Group M had a higher incidence of degenerative scoliosis than group O and a significantly larger Cobb angle. Conclusions: We should pay close attention to the GV location on the preoperative image when using LLIF, particularly in female patients with degenerative scoliosis. Full article

(This article belongs to the Special Issue Lumbar Spine Surgery: Causes, Complications and Management)

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11 pages, 1249 KiB

Open AccessArticle

Impact of Lumbar Surgery on Pharmacological Treatment for Patients with Lumbar Spinal Canal Stenosis: A Single-Center Retrospective Study

by Takaya Imai, Sota Nagai, Takehiro Michikawa, Risa Inagaki, Soya Kawabata, Kaori Ito, Kurenai Hachiya, Hiroki Takeda, Daiki Ikeda, Shigeki Yamada, Nobuyuki Fujita and Shinjiro Kaneko

J. Clin. Med. 2023, 12(6), 2385; https://doi.org/10.3390/jcm12062385 - 20 Mar 2023

Cited by 1 | Viewed by 1288

Abstract

Treatment for lumbar spinal canal stenosis (LSCS) is mainly classified into conservative and surgical therapies. Among conservative therapies, pharmacological treatment is commonly prescribed for LSCS. Meanwhile, surgical treatment is the last option for LSCS. This study aimed to examine the impact of lumbar surgery on pharmacological treatment for patients with LSCS. Consecutive patients aged ≥ 40 years who underwent lumbar surgery for LSCS were identified. A total of 142 patients were retrospectively reviewed for preoperative and 6-month and 1-year postoperative LSCS medications. The results showed that the number of LSCS medications significantly decreased after lumbar surgery. The proportion of the patients taking non-steroidal anti-inflammatory drugs, pregabalin/mirogabalin, opioids, prostaglandin E1 analogs, and neurotropin was significantly decreased after lumbar surgery, but that of the patients taking mecobalamin, acetaminophen, and serotonin-noradrenalin reuptake inhibitors was not significantly changed. Additionally, around 15% of the participants showed an increase in LSCS medications even after lumbar surgery. Multivariable analysis revealed that individuals without improvements in walking ability (RR: 2.7, 95% CI: 1.3–5.9) or social life (RR: 2.3, 95% CI: 1.1–5.0) had a greater risk of a postoperative increase in LSCS medications. The study results may provide physicians with beneficial information on treatment for LSCS. Full article

(This article belongs to the Special Issue Lumbar Spine Surgery: Causes, Complications and Management)

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10 pages, 1228 KiB

Open AccessArticle

Complications after Posterior Lumbar Fusion for Degenerative Disc Disease: Sarcopenia and Osteopenia as Independent Risk Factors for Infection and Proximal Junctional Disease

by Alberto Ruffilli, Marco Manzetti, Francesca Barile, Marco Ialuna, Tosca Cerasoli, Giovanni Viroli, Francesca Salamanna, Deyanira Contartese, Gianluca Giavaresi and Cesare Faldini

J. Clin. Med. 2023, 12(4), 1387; https://doi.org/10.3390/jcm12041387 - 09 Feb 2023

Cited by 3 | Viewed by 1496

Abstract

Proximal Junctional Disease (PJD) and Surgical Site Infection (SSI) are among the most common complications following spine surgery. Their risk factors are not fully understood. Among them, sarcopenia and osteopenia have recently been attracting interest. The aim of this study is to evaluate their influence on mechanical or infective complications after lumbar spine fusion. Patients who underwent open posterior lumbar fusion were analyzed. Through preoperative MRI, central sarcopenia and osteopenia were measured with the Psoas Lumbar Vertebral Index (PLVI) and the M-Score, respectively. Patients were stratified by low vs. high PLVI and M-Score and then by postoperative complications. Multivariate analysis for independent risk factors was performed. A total of 392 patients (mean age 62.6 years, mean follow up 42.4 months) were included. Multivariate linear regression identified comorbidity Index (p = 0.006), and dural tear (p = 0.016) as independent risk factors for SSI, and age (p = 0.014) and diabetes (p = 0.43) for PJD. Low M-score and PLVI were not correlated to a higher complications rate. Age, comorbidity index, diabetes, dural tear and length of stay are independent risk factors for infection and/or proximal junctional disease in patients who undergo lumbar arthrodesis for degenerative disc disease, while central sarcopenia and osteopenia (as measured by PLVI and M-score) are not. Full article

(This article belongs to the Special Issue Lumbar Spine Surgery: Causes, Complications and Management)

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14 pages, 1301 KiB

Open AccessArticle

A Comparative Analysis of Bi-Portal Endoscopic Spine Surgery and Unilateral Laminotomy for Bilateral Decompression in Multilevel Lumbar Stenosis Patients

by Dong-Chan Eun, Yong-Ho Lee, Jin-Oh Park, Kyung-Soo Suk, Hak-Sun Kim, Seong-Hwan Moon, Si-Young Park, Byung-Ho Lee, Sang-Jun Park, Ji-Won Kwon and Sub-Ri Park

J. Clin. Med. 2023, 12(3), 1033; https://doi.org/10.3390/jcm12031033 - 29 Jan 2023

Cited by 6 | Viewed by 1912

Abstract

The clinical and radiological results before and after surgery were compared and analyzed for patients with multilevel lumbar stenosis who underwent bi-portal endoscopic spine surgery (BESS) and microscopic unilateral laminotomy for bilateral decompression (ULBD). We retrospectively identified 47 and 49 patients who underwent BESS and microscopic ULBD, respectively, who were diagnosed with multi-level lumbar stenosis. Clinical outcomes were evaluated using the visual analog scale score for both back and leg pain, and medication (pregabalin) use and Oswestry Disability Index (ODI) scores for overall treatment outcomes were used pre-operatively and at the final follow-up. Radiological outcomes were evaluated as the percentage of dura expansion volume, and percentage preservation of both facets and both lateral recess angles. The follow-up period of patients was about 17.04 months in the BESS group and about 16.90 months in the microscopic ULBD group. The back and leg visual analog scale (VAS) scores and average pregabalin use decreased more significantly in the BESS group than in the microscopic ULBD group (each p-value 0.0443, <0.001, 0.0378). All radiological outcomes were significantly higher in the BESS group than in the ULBD group. The change in ODI in two-level spinal stenosis showed a significantly higher value in the BESS group compared to the microscopic ULBD group (p-value 0.0335). Multilevel decompression with the BESS technique in multiple spinal stenosis is an adequate technique as it shows better clinical and radiological results than microscopic ULBD during a short-term follow-up period. Full article

(This article belongs to the Special Issue Lumbar Spine Surgery: Causes, Complications and Management)

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11 pages, 3173 KiB

Open AccessArticle

Potential Involvement of Oxidative Stress in Ligamentum Flavum Hypertrophy

by Kei Ito, Hideki Kise, Satoshi Suzuki, Sota Nagai, Kurenai Hachiya, Hiroki Takeda, Soya Kawabata, Daiki Ikeda, Keiyo Takubo, Shinjiro Kaneko and Nobuyuki Fujita

J. Clin. Med. 2023, 12(3), 808; https://doi.org/10.3390/jcm12030808 - 19 Jan 2023

Cited by 2 | Viewed by 1594

Abstract

Oxidative stress (OS) results in many disorders, of which degenerative musculoskeletal conditions are no exception. However, the interaction between OS and ligamentum flavum (LF) hypertrophy in lumbar spinal canal stenosis is not clearly understood. The first research question was whether OS was involved in LF hypertrophy, and the second was whether the antioxidant N-acetylcysteine (NAC) was effective on LF hypertrophy. In total, 47 LF samples were collected from patients with lumbar spinal disorders. The cross-sectional area of LF was measured on axial magnetic resonance imaging. Immunohistochemistry of 8-OHdG and TNF-α were conducted on human LF samples. A positive association was found between 8-OHdG or TNF-α expression and cross-sectional area of LF. Flow cytometry analysis showed that H₂O₂, buthionine sulfoximine, and TNF-α treatment significantly increased intracellular reactive oxygen species in primary LF cells. NAC inhibited the induction of LF hypertrophy markers by OS or TNF in a real-time reverse transcriptase polymerase chain reaction and enzyme-linked immunosorbent assay. Western blotting analysis indicated that p38, Erk, and p65 phosphorylation were involved in intracellular OS signaling in LF cells. In conclusion, our results indicated that OS could be a therapeutic target for LF hypertrophy. Although this study included no in vivo studies to examine the longitudinal efficacy of NAC on LF hypertrophy, NAC may have potential as a therapeutic agent against lumbar spinal canal stenosis. Full article

(This article belongs to the Special Issue Lumbar Spine Surgery: Causes, Complications and Management)

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11 pages, 820 KiB

Open AccessArticle

Clinical Implication of the Acumen Hypotension Prediction Index for Reducing Intraoperative Haemorrhage in Patients Undergoing Lumbar Spinal Fusion Surgery: A Prospective Randomised Controlled Single-Blinded Trial

by Jung Min Koo, Hoon Choi, Wonjung Hwang, Sang Hyun Hong, Sang-Il Kim, Young-Hoon Kim, Seungtae Choi, Chang Jae Kim and Min Suk Chae

J. Clin. Med. 2022, 11(16), 4646; https://doi.org/10.3390/jcm11164646 - 09 Aug 2022

Cited by 2 | Viewed by 1548

Abstract

We investigated the clinical implication of the Hypotension Prediction Index (HPI) in decreasing amount of surgical haemorrhage and requirements of blood transfusion compared to the conventional method (with vs. without HPI monitoring). A prospective, randomised controlled-trial of 19- to 73-year-old patients (n = 76) undergoing elective lumbar spinal fusion surgery was performed. According to the exclusion criteria, the patients were divided into the non-HPI (n = 33) and HPI (n = 35) groups. The targeted-induced hypotension systolic blood pressure was 80–100 mmHg (in both groups), with HPI > 85 (in the HPI group). Intraoperative bleeding was lower in the HPI group (299.3 ± 219.8 mL) than in the non-HPI group (532 ± 232.68 mL) (p = 0.001). The non-HPI group had a lower level of haemoglobin at the end of the surgery with a larger decline in levels. The incidence of postoperative transfusion of red blood cells was higher in the non-HPI group than in the HPI group (9 (27.3%) vs. 1 (2.9%)). The use of HPI monitoring may play a role in providing timely haemodynamic information that leads to improving the quality of induced hypotension care and to ameliorate intraoperative surgical blood loss and postoperative demand for blood transfusion in patients undergoing lumbar fusion surgery. Full article

(This article belongs to the Special Issue Lumbar Spine Surgery: Causes, Complications and Management)

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9 pages, 255 KiB

Open AccessArticle

Prognostic Factors and Optimal Surgical Management for Lumbar Spinal Canal Stenosis in Patients with Diffuse Idiopathic Skeletal Hyperostosis

by Hideaki Nakajima, Kazuya Honjoh, Shuji Watanabe and Akihiko Matsumine

J. Clin. Med. 2022, 11(14), 4133; https://doi.org/10.3390/jcm11144133 - 16 Jul 2022

Cited by 1 | Viewed by 1190

Abstract

Lumbar spinal canal stenosis (LSS) and diffuse idiopathic skeletal hyperostosis (DISH) tend to develop in the elderly, resulting in an increased need for lumbar surgery. However, DISH may be a risk factor for poor clinical outcomes following lumbar decompression surgery, especially in patients with DISH extending to the lumbar segment (L-DISH). This study aimed to identify the prognostic factors of LSS with L-DISH and propose an optimal surgical management approach to improve clinical outcomes. Of 934 patients who underwent lumbar decompression surgery, 145 patients (15.5%) had L-DISH. In multivariate linear regression analysis of the JOA score improvement rate, the presence of vacuum phenomenon at affected segments (estimate: −15.14) and distance between the caudal end of L-DISH and decompressed/fused segments (estimate: 7.05) were independent prognostic factors. In logistic regression analysis of the surgical procedure with JOA improvement rate > 25% in L-DISH patients with both negative prognostic factors, the odds ratios of split laminotomy and short-segment fusion were 0.64 and 0.21, respectively, with conventional laminotomy as the reference. Therefore, to achieve better clinical outcomes in cases with decompression at the caudal end of L-DISH, decompression surgery without fusion sparing the osteoligamentous structures at midline should be considered as the standard surgery. Full article

(This article belongs to the Special Issue Lumbar Spine Surgery: Causes, Complications and Management)

Review

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21 pages, 16235 KiB

Open AccessReview

Complications in Spinal Fusion Surgery: A Systematic Review of Clinically Used Cages

by Francesca Veronesi, Maria Sartori, Cristiana Griffoni, Marcelo Valacco, Giuseppe Tedesco, Paolo Francesco Davassi, Alessandro Gasbarrini, Milena Fini and Giovanni Barbanti Brodano

J. Clin. Med. 2022, 11(21), 6279; https://doi.org/10.3390/jcm11216279 - 25 Oct 2022

Cited by 11 | Viewed by 2958

Abstract

Spinal fusion (SF) comprises surgical procedures for several pathologies that affect different spinal levels, and different cages are employed in SF surgery. Few clinical studies highlight the role of cages in complications beyond the outcomes. The aim of this systematic review is to collect the last 10 years’ worth of clinical studies that include cages in SF surgery, focusing on complications. Three databases are employed, and 21 clinical studies are included. The most-performed SF procedure was anterior cervical discectomy and fusion (ACDF), followed by lumbar SF. The polyetheretherketone (PEEK) cage was the most-used, and it was usually associated with autograft or calcium phosphate ceramics (hydroxyapatite (HA) and tricalcium phosphate (βTCP)). For lumbar SF procedures, the highest percentages of subsidence and pseudoarthrosis were observed with PEEK filled with bone morphogenetic protein 2 (BMP2) and βTCP. For ACDF procedures, PEEK filled with autograft showed the highest percentages of subsidence and pseudoarthrosis. Most studies highlighted the role of surgical techniques in patient complications. There are many interacting events that contextually affect the rate of clinical success or failure. Therefore, in future clinical studies, attention should focus on cages to improve knowledge of chemical, biological and topographical characteristics to improve bone growth and to counteract complications such as cage loosening or breaking and infections. Full article

(This article belongs to the Special Issue Lumbar Spine Surgery: Causes, Complications and Management)

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12 pages, 1455 KiB

Open AccessReview

Analysis of the Classification Systems for Thoracolumbar Fractures in Adults and Their Evolution and Impact on Clinical Management

by Bogdan Costachescu, Cezar Eugen Popescu and Bogdan Florin Iliescu

J. Clin. Med. 2022, 11(9), 2498; https://doi.org/10.3390/jcm11092498 - 29 Apr 2022

Cited by 3 | Viewed by 2969

Abstract

Although they represent a significant chapter of traumatic pathology with a deep medical and social impact, thoracolumbar fractures have proven to be elusive in terms of a definitive classification. The ever-changing concept of the stability of a thoracolumbar injury (from Holdsworth’s two-column concept to Denis’ three-column theory), the meaningful integration of neurological deficit, and a reliable clinical usability have made reaching a universally accepted and reproductible classification almost impossible. The advent of sophisticated imaging techniques and an improved understanding of spine biomechanics led to the development of several classification systems. Each successive system has contributed significantly to the understanding of physiopathological mechanisms and better treatment management. Magerl et al. developed a comprehensive classification system based on progressive morphological damage determined by the following three fundamental forces: compression, distraction, and axial torque. Vaccaro et al. devised the thoracolumbar injury severity score based on the following three independent variables: the morphology of the injury, posterior ligamentous complex (PLC) integrity, and neurological status at the time of injury. However, there are limitations to the classification system, especially when magnetic resonance imaging yields an uncertain status of PLC. The authors review the various classification systems insisting on their practical relevance and caveats and illustrate the advantages and disadvantages of the most widely used systems with relevant cases from their practice. Full article

(This article belongs to the Special Issue Lumbar Spine Surgery: Causes, Complications and Management)

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Other

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11 pages, 8878 KiB

Open AccessSystematic Review

Decompression with or without Fusion for Lumbar Synovial Cysts—A Systematic Review and Meta-Analysis

by Alberto Benato, Grazia Menna, Alessandro Rapisarda, Filippo Maria Polli, Manuela D’Ercole, Alessandro Izzo, Quintino Giorgio D’Alessandris and Nicola Montano

J. Clin. Med. 2023, 12(7), 2664; https://doi.org/10.3390/jcm12072664 - 03 Apr 2023

Cited by 3 | Viewed by 1504

Abstract

The management of symptomatic lumbar synovial cysts (LSC) is still a matter of debate. Previous systematic reviews did not stratify data according to different treatment techniques or incompletely reported comparative data on patients treated with lumbar posterior decompression (LPD) and lumbar decompression and fusion (LDF). The aim of our study was to compare LPD and LDF via a systematic review and meta-analysis of the existing literature. The design of this study was in accordance with the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The review questions were as follows: among patients suffering from symptomatic lumbar synovial cysts (population) and treated with either posterior lumbar decompression or posterior decompression with fusion (intervention), who gets the best results (outcome), in terms of cyst recurrence, reoperation rates, and improvement of postoperative symptoms (comparison)? The search of the literature yielded a total of 1218 results. Duplicate records were then removed (n = 589). A total of 598 articles were screened, and 587 records were excluded via title and abstract screening; 11 studies were found to be relevant to our research question and were assessed for eligibility. Upon full-text review, 5 were excluded because they failed to report any parameter separately for both LPD and LDF. Finally, 6 studies for a total of 657 patients meeting the criteria stated above were included in the present investigation. Our analysis showed that LDF is associated with better results in terms of lower postoperative back pain and cyst recurrence compared with LPD. No differences were found in reoperation rates and complication rates between the two techniques. The impact of minimally invasive decompression techniques on the different outcomes in LSC should be assessed in the future and compared with instrumentation techniques. Full article

(This article belongs to the Special Issue Lumbar Spine Surgery: Causes, Complications and Management)

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22 pages, 682 KiB

Open AccessSystematic Review

Comparison of Three Common Intervertebral Disc Discectomies in the Treatment of Lumbar Disc Herniation: A Systematic Review and Meta-Analysis Based on Multiple Data

by Xiao-ming Zhao, An-fa Chen, Xiao-xiao Lou and Yin-gang Zhang

J. Clin. Med. 2022, 11(22), 6604; https://doi.org/10.3390/jcm11226604 - 08 Nov 2022

Cited by 6 | Viewed by 1637

Abstract

Objective: Due to recent developments and the wide application of percutaneous transforaminal discectomy (PTED), we herein compare it with microendoscopic discectomy (MED) and traditional open surgery (OD) through surgical indicators and postoperative outcomes to evaluate the advantages and disadvantages of minimally invasive surgery PTED. Methods: This systematic review and meta-analysis was conducted in line with PRISMA guidelines (PROSPERO2018: CRD42018094890). We searched four English and two Chinese databases from the date of their establishment to May 2022. Randomized controlled trials and case–control studies of PTED versus MED or PTED versus OD in the treatment of lumbar disc herniation were retrieved. Results: A total of 33 studies with 6467 cases were included. When comparing MED with PTED, the latter had less intraoperative blood loss, smaller incision, shorter postoperative bed times, shorter hospitalization times, better postoperative visual analogue scale (VAS) for low back pain, and postoperative dysfunction index (Oswestry Disability Index, ODI) and higher recurrence rates and revision rates. However, operation times, postoperative VAS leg scores and complications, and successful operation rates were similar in both groups. Comparison of PTED with OD revealed in the former less intraoperative blood loss and smaller incision, shorter postoperative bed times, shorter hospitalization times, shorter operation times, and higher recurrence rates and revision rates. Nonetheless, comprehensive postoperative VAS scores, VAS leg pain scores, VAS low back pain, ODI and incidence of complications, and successful operation rates were similar between the two groups. Conclusions: The therapeutic effect and safety of PTED, MED and OD in the treatment of lumbar disc herniation were comparable. PTED had obvious advantages in that it is minimally invasive, with rapid recovery after surgery, but its recurrence rates and revision rates were higher than MED and OD. Therefore, it is not possible to blindly consider replacing MED and OD with PTED. Full article

(This article belongs to the Special Issue Lumbar Spine Surgery: Causes, Complications and Management)

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