Sequestrectomy versus microdiscectomy in the treatment of lumbar disc herniation: a meta-analysis.

BACKGROUND It remains unknown whether sequestrectomy provides better outcomes than microdiscectomy for lumbar herniated discs (LHD). Therefore, we conducted a meta-analysis to compare the effects of sequestrectomy and microdiscectomy in the treatment of patients with LHD. METHODS Clinical trials published in PubMed, Embase, and Web of Science were systematically reviewed to compare the effects of sequestrectomy and microdiscectomy for LHD. Outcomes included reherniation rate, duration of surgery, length of hospital stay, and postoperative Visual Analog Scale (VAS) scales for leg and back pains. A fixed-effects or random-effects were used to pool the estimates, depending on the heterogeneity among the studies. RESULTS Five cohorts and two randomized controlled trials (RCTs) with a total of 929 patients met the inclusion criteria and were included in this meta-analysis. All patients underwent sequestrectomy or microdiscectomy. Pooled estimates showed that patients treated with sequestrectomy had comparable effects in reherniation rate (RR = 1.36, 95% CI: 0.81, 2.27; P = 0.240), length of hospital stay (WMD = -0.22 days, 95% CI: -0.45, 0.01; P = 0.060), and postoperative VAS scales for leg pain (WMD = 0.53, 95% CI: -1.54, 2.60; P = 0.617) or back pain (WMD = 0.18, 95% CI: -1.64, 2.00; P = 0.846), but had a shorter duration of surgery (WMD = -6.97 minutes, 95% CI: -12.15, -1.78; P = 0.008), when compared with those treated with microdiscectomy. CONCLUSION Based on the current evidence, sequestrectomy significantly reduced the operational time, but had similar effects on reherniation rate, length of hospital stay, and postoperative VAS scales for leg and back pains, when compared with microdiscectomy. Further well-designed randomized controlled studies are needed to identify our findings.