Surgical Outcomes for Upper Lumbar Disc Herniations: A Systematic Review and Meta-analysis

Murray Echt, Ryan Holland, Wenzhu Mowrey, Phillip Cezayirli, Rafael De la Garza Ramos, Mousa Hamad, Yaroslav Gelfand, Michael Longo, Merritt D. Kinon, Vijay Yanamadala, Saad Chaudhary, Samuel K. Cho, Reza Yassari

Research output: Contribution to journalReview articlepeer-review

Abstract

Study Design: Systematic review and meta-analysis. Objective: To conduct a literature review on outcomes of discectomy for upper lumbar disc herniations (ULDH), estimate pooled rates of satisfactory outcomes, compare open laminectomy/microdiscectomy (OLM) versus minimally invasive surgical (MIS) techniques, and compare results of disc herniations at L1-3 versus L3-4. Methods: A systematic review of articles reporting outcomes of nonfusion surgical treatment of L1-2, L2-3, and/or L3-4 disc herniations was performed. The inclusion and exclusion of studies was performed according to the latest version of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Results: A total of 20 articles were included in the quantitative meta-analysis. Pooled proportion of satisfactory outcome (95% CI) was 0.77 (0.70, 0.83) for MIS and 0.82 (0.78, 0.84) for OLM. There was no significant improvement with MIS techniques compared with standard OLM, odds ratio (OR) = 0.86, 95% CI (0.42, 1.74), P =.66. Separating results by levels revealed a trend of higher satisfaction with L3-4 versus L1-3 with OLM surgery, OR = 0.46, 95% CI (0.19, 1.12), P =.08. Conclusion: Our analysis reveals that discectomy for ULDH has an overall success rate of approximately 80% and has not improved with MIS. Discectomy for herniations at L3-4 trends toward better outcomes compared with L1-2 and L2-3, but was not significant.

Original languageEnglish (US)
Pages (from-to)802-813
Number of pages12
JournalGlobal Spine Journal
Volume11
Issue number5
DOIs
StatePublished - Jun 2021

Keywords

  • discectomy
  • intervertebral disc degeneration
  • intervertebral disc disease
  • intervertebral disc displacement
  • laminectomy
  • odds ratio

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine
  • Clinical Neurology

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