| Background: Lumbar disc herniation(LDH)is a clinical syndrome caused by degenerative changes in the lumbar disc,the breakdown of the annulus fibrosus under the action of external forces or long-term loads,irritation or compression of nerve roots by herniated nucleus pulposus,cauda equina nerve,manifesting as low back pain,radiating pain in the lower extremities,numbness in the lower extremities,weakness and fecal dysfunction.The latest guidelines mention that patients have a history,symptoms,signs,and imaging findings corresponding to lumbar disc herniation,and that imaging consistent with neurolocalization is diagnostic of lumbar disc herniation.Radiographically,the findings alone are of a disc extending beyond the adjacent margins,whereas the absence of associated clinical findings is diagnostic only of lumbar disc herniation.Because low back pain and radiation pain of the lower extremities are the most common symptoms and can be easily confused clinically with other diseases causing low back pain and leg pain,they often need to be differentiated from other diseases such as psoas muscle strain,lumbar transverse syndrome,injury to the supraspinal and interspinous ligaments,spondylolisthesis,lumbar stenosis,lumbar tuberculosis,intraspinal tumors,nerve root and cauda equina tumors.The treatment of lumbar disc herniation has two components,surgical treatment and non-surgical treatment,which need to be selected according to the different conditions and complaints of the patients.Current surgical treatments for lumbar disc herniation include two types,open surgery and minimally invasive surgery,in which minimally invasive access lumbar interbody fusion(minimally invasive-Transforaminal Lumbar Interbody Fusions,MIS-TLIF)the surgical approach is via the multifidus with the longissimus intermuscular space in the lumbar paraspinal column,which does not require extensive dissection,causes little injury and little bleeding via the intermuscular space approach alone,while the transforaminal approach can safely reveal the nerve root and dural sac,intraoperatively does not require excessive traction of the nerve root and dural sac,allows excellent removal of the disc tissue on the side of central deviation,Safer handling of the intervertebral space is possible.Meanwhile all screw implantations were percutaneous staples with little trauma to the patients and were safe and reliable.Because MIS TLIF surgery is characterized by small injury and less bleeding,there is an intense debate in the clinic as to whether the placement of drains is necessary postoperatively.Some scholars believe that prophylactic placement of drains should be routinely performed after spinal surgery to avoid the occurrence of postoperative hematoma and neurological deficits caused by hematoma compression.Another part of scholars believe that targeting MIS TLIF surgical drainage does not reduce the occurrence of postoperative epidural hematoma,but rather increases the chance of postoperative infection,which at the same time affects the healing of local soft tissue and prolongs the patient’s bed rest and hospital stay.In recent years,with the gradual increase in the clinical use of MIS TLIF surgery,there has been increasing debate about whether placement of drains is necessary after MIS TLIF surgery,so we performed this meta-analysis with the core goal of providing evidence-based evidence for practical clinical practice by analyzing and aggregating the relevant experiments that are currently conducted to verify the feasibility of not placing drains.Methods: This study was updated to February 2021 by a computerized search of Pub Med,Cochrane,EMBASE,web of science,CNKI,Wanfang,VIP,CBM.Literature screening,data extraction,quality scoring and statistical analysis of the data were performed according to the selection criteria of the literature.The outcome measures analyzed in this study included the following: Oswestry disability index score(ODI),visual analog scale(VAS)for pain,time to downstaging,length of hospital stay,and postoperative complication rate.This meta-analysis was performed strictly in accordance with the Cochrane Handbook and PRISMA statement and was registered in the international prospective register of systematic reviews.In statistical analysis,statistical analysis of the data was performed using Stata 15.1.Results: A total of 4 publications with 300 patients were included in this metaanalysis,including 144 patients in the no drain group and 156 patients in the no drain group,and the combined results showed that patients in the no drain group tended to fall significantly earlier than those in the no drain group(WMD = 1.02,95% CI(0.75,1.29),P < 0.001),and the length of hospital stay was significantly shorter than that in the placed drain group(WMD = 1.09,95% CI(0.79,1.39),P < 0.001];the degree of postoperative ODI remission of patients in the no placed drainage group was better than that in the placed Drainage Group [WMD =-1.27,95% CI(-2.26,-0.28),P = 0.012];there was no obvious difference between the placement of drainage and not in the extent of postoperative vas remission of patients.[WMD = 0.12,95% CI(-0.11,0.35),P =0.313];and not placing a drain did not increase the rate of postoperative complications[or = 1.59,95% CI(0.43,5.85),P = 0.489]Conclusions: The absence of drain placement after MIS TLIF can significantly reduce the length of hospital stay and bed rest without increasing the chance of postoperative pain as well as complications.However,because of the number of included literatures and the small sample size in this meta-analysis,multicenter,large sample,high-quality,double-blind RCT studies are expected to further update our conclusions. |
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