Transforaminal approach versus interlaminar approach

Background: To systematically analyze the differences of complications between percutaneous transforaminal endoscopic discectomy (PTED) and percutaneous interlaminar endoscopic discectomy (PIED) in the treatment of lumbar disc herniation.Methods: We performed a systematic search in MEDLINE, EMBASE, PubMed, Web of Science, Cochrane databases, Chinese Biomedical Literature Database, CNKI, and Wanfang Data for all relevant studies.All statistical analysis was performed using Review Manager Version 5.3.Results: A total of 15 articles with 1156 study subjects were included, with 550 patients in PTED group and 606 patients in PIED group.The results of the meta-analysis showed that postoperative dysesthesia (odds ratio [OR] = 0.61, 95% confidence interval [CI], 0.33-1.13),nerve root injury (OR = 1.22,95% CI, 0.30-5.02),surgical site wound complications (OR = 1.26, 95% CI, 0.29-5.40),recurrence (OR = 1.09, 95% CI, 0.54-2.21),conversion to open surgery (OR = 1.26, 95% CI, 0.33-4.81),incomplete decompression (OR = 1.62, 95% CI, 0.43-6.09),and total complication (OR = 0.72, 95% CI, 0.49-1.06)showed no significant differences between the PTED group and the PIED group, while the PTED group had significantly better results in dural tear compared with the PIED group (OR = 0.31, 95% CI, 0.13-0.79).Conclusions: Dural tear was significantly less occured in PTED compared with PIED.The postoperative dysesthesia, nerve root injury, surgical site wound complications, recurrence, conversion to open surgery, incomplete decompression, and total complication did not differ significantly between PTED and PIED in the treatment of lumbar disc herniation.