Posterior Approach Discectomy with or without Fusion for Lumbar Disc Herniation: A systematic Review_Chinese Journal of Evidence-Based Medicine

Authors：

YUE Yong , Aier kensadeer

The first Affiliated Hospital of xinjiang Medical University, Urumqi 830054, china;

Corresponding author：

Keywords：

Lumbar disc herniation; Decompression; Fusion; Systematic review; Clinical controlled trial

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective 　To evaluate the efficacy of posterior approach discectomy with and without fusion in the treatment of lumbar disc herniation.
Methods 　We searched MEDLINE (1950 to June 2007), OVID (1950 to April 2007), PUBMED, the China Biological Medicine Database (1978 to June 2007) and Wanfang Database (1981 to February 2007). We also handsearched several relevant journals for randomized controlled trials (RCTs) and quasi-randomized controlled trials (quasi-RCTs) comparing posterior approach discectomy with and without fusion in the treatment of lumbar disc herniation. The quality of the included trials was assessed. The Cochrane Collaboration’s RevMan 4.2.8 software was used for statistical analysis.
Results 　Nine eligible trials involving 1911 patients were included. The meta-analyses found no statistically significant differences between the two operative procedures in the incidence of postoperative leg pain [RR 0.94, 95%CI (0.69, 1.28)], the proportion of patients requiring re-operation [RR 0.77, 95% CI (0.57, 1.04)], the incidence of post-operative lumbar canal stenosis [RR 1.23, 95%CI (0.26, 5.86)], and the relapse rate at other intervertebral spaces [RR 1.05, 95%CI (0.49, 2.26)] (P gt;0.05).There is statistically significant differences between the two group in the incidence of peri-operative complications [RR 1.46, 95%CI (1.06, 2.00)]. Discectomy plus fusion was superior to discectomy alone in incidence of postoperative back pain [RR 0.70, 95%CI (0.53, 0.94)], relapse rate at either intervertebral space [RR 0.30, 95%CI (0.18, 0.48)] and at the same intervertebral space [RR 0.12, 95%CI (0.04, 0.37)].
Conclusions 　Since all the included studies were controlled trials with a great potential for biases, high-quality, large-scale randomized controlled trials are required.

Citation： YUE Yong,Aier kensadeer. Posterior Approach Discectomy with or without Fusion for Lumbar Disc Herniation: A systematic Review. Chinese Journal of Evidence-Based Medicine, 2007, 07(7): 523-530. doi: Copy

1.	Ru DK. Is fusion necessary in the treatment of lumbar disc herniation? Chinese Journal of Spine and Spinal Cord, 2006, 16(4): 246-247.
2.	Hu YG, Chen BH. The indication of the lumbar disc herniation treated by fusion in classical operation. Chinese Journal of Spine and Spinal Cord, 2006, 16(4): 247-248.
3.	Men XZ, Men XG, Shen Y, et al. The analysis of the effective of the single recurrent lumbar disc herniation treated by various operation. Chinese Journal of Spine and Spinal Cord, 2006, 16(9): 671-673.
4.	Hou SX, Li MQ, Bai W, et al. Long term results of discectomy for lumbar disc herniation. Chin J Orthop, 2003, 23(9): 513-517 .
5.	Guo JJ, Tang TS, Yang HL, et al. Long-term outcomes of the revision open lumbar discectomy by fenestration: a follow-up study of more than 10 years. Chinese Journal of Surgery, 2005, 43(16): 1075-1079.
6.	Jin AM, Zhang H, Liu WL, et al. Surgical therapy of lumbar disc herniation in 6815 cases. J First Mil Med Univ, 2002, 22(4): 351-353.
7.	Zhu LG, Wang SQ, Yang KX, et al. Treatment of Lumbar Disc Herniation with Pedicle Screw Fixation Systems. Chinese Journal of Bone and Joint Injury, 2006, 21(2):94-96.
8.	Nachlas IW. End-reselt of treatment of herniated nucleus polposus by excision with fusion and without fusion. Journal of Bone and Joint Surgery, 1952, 34: 981-988.
9.	Barr JS, Kubik GS, Molloy MK, et al. Evaluation of end results in treatment of ruptured lumbar intervertebral discs with protrusion of nucleus pulposus. Surg Gynecol Obstet, 1967, 125: 250-256.
10.	Frymoyer JW, Hanley E, Howe J, et al. Disc excision and spine fusion in the management of lumbar disc disease. A minimum of ten year follow-up. Spine, 1978, 3: 361-365.
11.	Eri N. Comparison of the results in patients operated upon for ruptured lumbar discs with and without spinal fusion. Acta Neurochir, 1978, 41(1-3):107-113.
12.	White AH, von Rogov P, Zucherman J, et al. Lumbar laminectomy for herniated disc: a prospective controlled comparison with internal fixation fusion. Spine, 1987, 12(3): 305-307.
13.	Vaughan PA, Malcolm BW, Maistrelli GL. Results of L4-L5 Disc Excision Alone Versus Disc Excision and Fusion. Spine, 1988, 13(6): 690-695.
14.	Takeshima T, Kambara K, Miyata S, et al. Clinical and radiographic evaluation of disc excision for lumbar disc herniation with and without posterolateral fusion. Spine, 2000, 25(4): 450-456.
15.	Malhar N, Kumar FJ, Hamilton H. Long-term follow-up of functional outcomes and radiographic changes at adjacent levels following lumbar spine fusion for degenerative disc disease. Eur Spine J, 2001, 10: 309-313.
16.	Satoh I,, Yonenobu K, Hosono N, et al. Indication of posterior lumbar interbody fusion for lumbar disc herniation. J Spinal Disord Tech, 2006, 19(2): 104-108.
17.	Rish BL. A Comparative evaluation of posterior lumbar body fusion for disc disease. Spine, 1985, 10: 855-857.
18.	阮狄克 . 腰椎间盘突出症手术治疗需要融合吗？中国脊柱脊髓杂志, 2006, 16(4): 246-247.
19.	胡有谷, 陈伯华. 腰椎间盘突出症经典手术时行腰椎融合的指征. 中国脊柱脊髓杂志, 2006, 16(4): 247-248.
20.	孟宪中, 孟宪国, 申勇, 等. 不同术式治疗复发性单节段腰椎间盘突出症的疗效分析. 中国脊柱脊髓杂志, 2006, 16(9): 671-673.
21.	Yorimitsu E, Chiba K, Toyama Y, et al. Long- term outcomes of standard discectomy for lumbar disc herniation : a follow-up study of more than 10years. Spine, 2001, 26 (6): 652-657.
22.	侯树勋, 李明全, 白巍, 等. 腰椎髓核摘除术远期疗效评价. 中华骨科杂志, 2003, 23(9): 513-517 .
23.	郭炯炯, 唐天驷, 杨惠林, 等. 开窗腰椎间盘切除再手术的远期随访. 中华外科杂志, 2005, 43(16): 1075-1079 .
24.	靳安民, 张辉, 刘成龙, 等. 6815例腰椎间盘突出症的手术治疗. 第一军医大学学报, 2002, 22(4): 351-353.
25.	Loupasis G, Stamos K, Katonis P. Seven-to 20-years outcome of lumbar discectomy. Spine, 1999, 24(22): 2313-2317 .
26.	朱立国, 王尚全, 杨克新, 等. 腰椎经椎弓根螺钉系统内固定治疗腰椎间盘突出症. 中国骨与关节损伤杂志, 2006, 21(2): 94-96.

1. Ru DK. Is fusion necessary in the treatment of lumbar disc herniation? Chinese Journal of Spine and Spinal Cord, 2006, 16(4): 246-247.
2. Hu YG, Chen BH. The indication of the lumbar disc herniation treated by fusion in classical operation. Chinese Journal of Spine and Spinal Cord, 2006, 16(4): 247-248.
3. Men XZ, Men XG, Shen Y, et al. The analysis of the effective of the single recurrent lumbar disc herniation treated by various operation. Chinese Journal of Spine and Spinal Cord, 2006, 16(9): 671-673.
4. Hou SX, Li MQ, Bai W, et al. Long term results of discectomy for lumbar disc herniation. Chin J Orthop, 2003, 23(9): 513-517 .
5. Guo JJ, Tang TS, Yang HL, et al. Long-term outcomes of the revision open lumbar discectomy by fenestration: a follow-up study of more than 10 years. Chinese Journal of Surgery, 2005, 43(16): 1075-1079.
6. Jin AM, Zhang H, Liu WL, et al. Surgical therapy of lumbar disc herniation in 6815 cases. J First Mil Med Univ, 2002, 22(4): 351-353.
7. Zhu LG, Wang SQ, Yang KX, et al. Treatment of Lumbar Disc Herniation with Pedicle Screw Fixation Systems. Chinese Journal of Bone and Joint Injury, 2006, 21(2):94-96.
8. Nachlas IW. End-reselt of treatment of herniated nucleus polposus by excision with fusion and without fusion. Journal of Bone and Joint Surgery, 1952, 34: 981-988.
9. Barr JS, Kubik GS, Molloy MK, et al. Evaluation of end results in treatment of ruptured lumbar intervertebral discs with protrusion of nucleus pulposus. Surg Gynecol Obstet, 1967, 125: 250-256.
10. Frymoyer JW, Hanley E, Howe J, et al. Disc excision and spine fusion in the management of lumbar disc disease. A minimum of ten year follow-up. Spine, 1978, 3: 361-365.
11. Eri N. Comparison of the results in patients operated upon for ruptured lumbar discs with and without spinal fusion. Acta Neurochir, 1978, 41(1-3):107-113.
12. White AH, von Rogov P, Zucherman J, et al. Lumbar laminectomy for herniated disc: a prospective controlled comparison with internal fixation fusion. Spine, 1987, 12(3): 305-307.
13. Vaughan PA, Malcolm BW, Maistrelli GL. Results of L4-L5 Disc Excision Alone Versus Disc Excision and Fusion. Spine, 1988, 13(6): 690-695.
14. Takeshima T, Kambara K, Miyata S, et al. Clinical and radiographic evaluation of disc excision for lumbar disc herniation with and without posterolateral fusion. Spine, 2000, 25(4): 450-456.
15. Malhar N, Kumar FJ, Hamilton H. Long-term follow-up of functional outcomes and radiographic changes at adjacent levels following lumbar spine fusion for degenerative disc disease. Eur Spine J, 2001, 10: 309-313.
16. Satoh I,, Yonenobu K, Hosono N, et al. Indication of posterior lumbar interbody fusion for lumbar disc herniation. J Spinal Disord Tech, 2006, 19(2): 104-108.
17. Rish BL. A Comparative evaluation of posterior lumbar body fusion for disc disease. Spine, 1985, 10: 855-857.
18. 阮狄克 . 腰椎间盘突出症手术治疗需要融合吗？中国脊柱脊髓杂志, 2006, 16(4): 246-247.
19. 胡有谷, 陈伯华. 腰椎间盘突出症经典手术时行腰椎融合的指征. 中国脊柱脊髓杂志, 2006, 16(4): 247-248.
20. 孟宪中, 孟宪国, 申勇, 等. 不同术式治疗复发性单节段腰椎间盘突出症的疗效分析. 中国脊柱脊髓杂志, 2006, 16(9): 671-673.
21. Yorimitsu E, Chiba K, Toyama Y, et al. Long- term outcomes of standard discectomy for lumbar disc herniation : a follow-up study of more than 10years. Spine, 2001, 26 (6): 652-657.
22. 侯树勋, 李明全, 白巍, 等. 腰椎髓核摘除术远期疗效评价. 中华骨科杂志, 2003, 23(9): 513-517 .
23. 郭炯炯, 唐天驷, 杨惠林, 等. 开窗腰椎间盘切除再手术的远期随访. 中华外科杂志, 2005, 43(16): 1075-1079 .
24. 靳安民, 张辉, 刘成龙, 等. 6815例腰椎间盘突出症的手术治疗. 第一军医大学学报, 2002, 22(4): 351-353.
25. Loupasis G, Stamos K, Katonis P. Seven-to 20-years outcome of lumbar discectomy. Spine, 1999, 24(22): 2313-2317 .
26. 朱立国, 王尚全, 杨克新, 等. 腰椎经椎弓根螺钉系统内固定治疗腰椎间盘突出症. 中国骨与关节损伤杂志, 2006, 21(2): 94-96.

Chinese Journal of Evidence-Based Medicine

Posterior Approach Discectomy with or without Fusion for Lumbar Disc Herniation: A systematic Review

Abstract Full text Figures/Tables Video References Cited by

Format

Content