| Patient or population: patients with degenerative disc disease Intervention: minimally invasive discectomy Comparison: conventional open surgery Outcomes: functional outcomes, pain, complications, reoperation | |||
|---|---|---|---|
| Outcome (instrument) | Anticipated absolute effect, risk with MIS (95% CI) | No. of participants (studies) | GRADE quality of evidence |
| Short-term function (ODI, JOA, NASS or RDQ) Follow-up: < 6 mo | Cervical: Mean short-term function was 0.18 SDs higher (0.10 lower to 0.46 higher)† Lumbar: Mean short-term function was 0.04 SDs lower (0.18 lower to 0.09 higher)† | Cervical: 200 (1) Lumbar: 839 (7) | Moderate* |
| Long-term function (ODI, JOA, NASS or RDQ) Follow-up: < 2 yr | Cervical: Mean long-term function was 0.11 SDs higher (0.09 lower to 0.31 higher)† Lumbar: Mean long-term function was 0.04 SDs higher (0.11 lower to 0.20 higher)† | Cervical: 390 (3) Lumbar: 982 (7) | Moderate* |
| Short-term extremity pain (VAS) Follow-up: < 6 mo | Cervical: Mean short-term arm pain was 0.25 SDs lower (1.04 lower to 0.53 higher)† Lumbar: Mean short-term leg pain was 0.15 SDs higher (0.02 lower to 0.31 higher)† | Cervical: 361 (3) Lumbar: 865 (6) | Low*‡ |
| Long-term extremity pain (VAS) Follow-up: < 2 yr | Cervical: Mean short-term arm pain was 0.21 SDs lower (0.52 lower to 0.10 higher)† Lumbar: Mean short-term leg pain was 0.08 SDs higher (0.16 lower to 0.32 higher)† | Cervical: 431 (4) Lumbar: 792 (6) | Low*‡ |
| Short-term axial pain (VAS) Follow-up: < 6 mo | Cervical: Mean short-term neck pain was 0.48 SDs lower (0.94 to 0.01 lower)† Lumbar: Mean short-term back pain was 0.62 SDs lower (1.28 lower to 0.04 higher)† | Cervical: 361 (3) Lumbar: 825 (5) | Low*‡ |
| Long-term axial pain (VAS) Follow-up: < 2 yr | Cervical: Mean short-term neck pain was 0.01 SDs lower (0.28 to 0.26 lower)† Lumbar: Mean short-term back pain was 0.51 SDs lower (1.59 lower to 0.57 higher)† | Cervical: 431 (4) Lumbar: 670 (3) | Low*‡ |
| Adverse events | |||
| Complications, reoperation Follow-up: < 2 yr | Overall higher rates of nerve-root injury (RR 1.62, 95% CI 0.45 to 5.84), incidental durotomy (RR 1.56, 95% CI 0.80 to 3.05) and reoperation (RR 1.48, 95% CI 0.97 to 2.26), but differences were not statistically significant Infections were more common in open-surgery group (RR 0.24, 95% CI 0.04 to1.38), but difference was not statistically significant | Cervical and lumbar: Up to 1262 (8) | Low*§ |
Note: CI = confidence interval, GRADE = Grading of Recommendations Assessment, Development, and Evaluation, JOA = Japanese Orthopaedic Association instrument, MIS = minimally invasive surgery, NASS = North American Spine Society instrument, ODI = Oswestry Disability index, RDQ = Roland Disability Quotient, RR = risk ratio, SD = standard deviation, VAS = visual analogue scale. *Downgraded because of risk of bias. †Effect failed to exceed minimal important difference (smallest effect that an informed patient would perceive as beneficial enough to justify a change in management in the absence of troublesome adverse effects and excessive cost). ‡Downgraded because of inconsistency. §Downgraded because of imprecision. GRADE Working Group grades of evidence: High quality: Further research is very unlikely to change our confidence in the estimate of effect. Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low quality: We are very uncertain about the estimate.