髓核摘除与椎间融合修复伴有Modic改变腰椎间盘突出症的Meta分析

Discectomy versus interbody fusion for lumbar disc herniation with Modic change: a meta-analysis

BACKGROUND: At present, a large number of studies have proved that the discectomy and interbody fusion are effective in treatment of lumbar disc herniation. But for the treatment of lumbar disc herniation with Modic change, the advantages and disadvantages of above two kinds of surgical methods are still inconclusive. OBJECTIVE: To systematically review the effectiveness of discectomy versus interbody fusion in treatment of lumbar disc herniation with Modic change. METHODS: We searched PubMed, Embase, The Cochrane Library (Issue 2, 2015), CBM, CNKI, VIP and WanFang database for randomized controlled trials on discectomy versus interbody fusion for lumbar disc herniation with Modic change from inception to May 1st, 2015. Clinical outcomes were back pain Visual Analog Scale, leg pain Visual Analog Scale, Oswestry Disability Index, lumbar Japanese Orthopaedic Association score, the number of cases affecting complications, and MacNab criteria. Meta-analysis was performed using RevMan 5.2 software. RESULTS AND CONCLUSION: Nine randomized controlled trials were included, involving 945 patients. The results of meta-analysis showed that compared with discectomy group, back pain Visual Analog Scale was lower MD=0.81, 95%CI (0.69, 0.92), P < 0.000 01]; Oswestry Disability Index was lower MD=2.07, 95%CI (1.62, 2.52), P < 0.000 01]; lumbar Japanese Orthopaedic Association score was higher MD=-2.32, 95%CI (-4.32, -0.32), P=0.02] in the interbody fusion group. No significant difference in leg pain Visual Analog Scale and MacNab criteria outcomes was detected between both groups. These findings verified that interbody fusion was safer and more effective for lumbar disc herniation with Modic change, compared with discectomy.