PED Versus MEDL For The Treatment Of Lumbar Spinal Stenosis

background: At present,there is no authoritative guide to propose a gold standa-rd procedure for the treatment of lumbar spinal stenosis(LSS).Percutaneous endoscopic decompression(PED)has made great progress in the past 20 years,sho-wing its unique advantages of minimally invasive technology and clinical efficac-y.Since the traditional micro endoscopic decompression(MEDL)was reported in 1995,through the continuous exploration of spinal surgeons and the further im-provement of the surgical system,it has its unique advantages in the treatment of lumbar spinal stenosis and has been accepted by clinicians.Therefore,it is ne-cessary to collect high-quality research and extract data for comprehensive and o-bjective evaluation and analysis,to provide a reliable reference for clinical treatment.Objective: To compare the efficacy and safety of percutaneous endoscopic decompression(PED)and traditional micro endoscopic decompression laminectomy(MEDL)in the treatment of lumbar spinal stenosis(LSS).Methods: By searching the Chinese and English databases of The Cochrane Libr-ary,Medline,Embase,China knowledge Network,Wanfang and Weipu,and sear-ching for randomized controlled trials(RCT)and retrospective case-controlled tri-als(CCT)related to the subject,the relevant data were extracted after strict eva-luation of the quality of the literature.The comparative studies of PED and ME DL in the treatment of lumbar spinal stenosis reported from the establishment of the database to December 2019 were obtained.The quality of randomized controlled trials was evaluated according to the criteria of the Cochrane Back Review Group.The quality of the cohort study was evaluated according to the New Castle-Ottawa scale.Rev Man5.3 software was used to analyze and evaluate the main results,including preoperative and postoperative low back pain VAS(Visual Analog Scale)score and ODI(Oswestry Disability Index),Mac Nab standard excellent and good rate and other major outcome indicators,including intraoperative blood loss,complications,recurrence,reoperation rate,operation time and hospital stay.The two researchers extracted the data independently and assessed the quality of each study.Results: A total of 8 literature studies,four randomized co-ntrolled studies,four non-randomized controlled studies were included,all of wh-ich were evaluated as moderate to high quality.A total of 804 patients were in volved in the study,and 714 patients were obtained in the last follow-up(the la-st follow-up rate was 88.8%).There were 405 patients in the PED treatment group and 399 patients in the MEDL treatment group.Both of them are safe and effective in the clinical application of lumbar spinal stenosis.VAS score of low back pain(preoperative subgroup: last follow-up subgroup after WMD=0.18,95%C I:-0.19~0.54,P=0.35,: WMD=0.01,95%CI:-0.16~0.18,P=0.91)and leg pain VAS s-c ore(preoperative subgroup: WMD=0.20,95%CI:-0.11~0.50,P=0.20,12 months subgroup: WMD=-0.05,95%CI:-0.22~0.13,ODI index(preoperative subgroup: WMD=-1.42,95%CI:-3.05~ 0.21,P=0.09,12 months after: WMD=0.03,95%CI:-0.52~ 0.58,P=0.90),Mac Nab standard excellent and good rate(OR=1.35,95%CI:0.71~2.58,P=0.36),complication rate(OR=0.59,95%CI:0.30~1.13,).Therewas no si-gnificant difference in operation time(WMD=11.69,95%CI:-2.92~26.29,P=0.12),r-ecurrence rate(OR=1.19,95%CI:0.43~3.32,P=0.74)and reoperation rate(OR=1.04,95%CI:0.42~2.58,P=0.94)between PED group and MEDL group.PED has more advantages in-hospital stay(WMD=-1.40,95%CI:2.40~-0.39,P=0.006),operative ski-n incision length(WMD=-1.16,95%CI:-1.19~-1.13,P < 0.00001)and intraoperative blood loss(WMD=-28.40,95%CI:-39.06~-17.75,P < 0.00001).Conclusion: 1)PED technology is shorter,less invasive,less bleeding,but needs to overcome a steeper learning curve than MEDL;MEDL technology radiation dose is less;there is no significant difference in operation time,complication rate,recurrence rate,low back pain VAS score,ODI index and Mac Nab standard excellent and good rate between the two groups.2)The choice of surgical treatment for lumbar spinal stenosis still needs more large samples and high-quality c-linical evidence.