Complications associated with lumbar discectomy surgical techniques: a systematic review

BACKGROUND: Open discectomy (OD) and microdiscectomy (MD) are routine procedures for the treatment of lumbar disc herniation. Minimally invasive surgery (MIS), such as micro-endoscopic discectomy (MED) and full endoscopic discectomy (FED), offers potential advantages (less pain, less bleeding, shorter hospitalisation and earlier return to work), but their complications have not yet been fully evaluated. The aim of this paper was to identify the frequency of these complications with a focus on MIS in comparison to OD/MD. METHODS: The authors conducted a Medline database search for randomised controlled and prospective cohort studies reporting complications associated with MIS and MD/OD from 1997 to February 2020. Included studies were assessed for bias using the Newcastle-Ottawa Quality assessment form. Mean complication rates for each technique were calculated by dividing the total number of each complication by the total number of patients included in the studies which reported that specific complication. RESULTS: Of the 1,095 articles retrieved from Medline, 35 met the inclusion criteria. OD, MD, MED and FED were associated with: recurrent lumbar disc hernias in 4.1%, 5.1%, 3.9% and 3.5% respectively; re-operations in 5.2%, 7.5%, 4.9% and 4% respectively; wound complications in 3.5%, 3.5%, 1.2% and 2% respectively; durotomy in 6.6%, 2.3%, 4.4% and 1.1% respectively; neurological complications in 1.8%, 2.8%, 4.5% and 4.9% respectively. Nerve root injury was reported in 0.3% for MD, 0.8% for MED and 1.2% for FED. DISCUSSION: This up-to-date systematic review of complications after various techniques of lumbar discectomy (including a large pool of patients who had MIS) confirms previous findings of low and comparable rates. However variable levels of bias were reported amongst included studies, which reported complications with varying levels of clinical detail.