Comparison of treatments for lumbar disc herniation: systematic review with network meta-analysis

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Study design: Systematic review with network meta-analysis. Objective: To compare patient outcomes of lumbar discectomy with bone-anchored annular closure (LD + AC), lumbar discectomy (LD), and continuing conservative care (CC) for treatment of lumbar disc herniation refractory to initial conservative management. Summary of background data: Several treatment options are available to patients with refractory symptoms of lumbar disc herniation, but their comparative efficacy is unclear. Methods: A systematic review was performed to compare efficacy of LD + AC, LD, and CC for treatment of lumbar disc herniation. Outcomes included leg pain, back pain, disability (each reported on a 0–100 scale), reherniation, and reoperation. Data were analyzed using random effects network meta-analysis. Results: This review included 14 comparative studies (8 randomized) involving 3947 patients—11 studies of LD versus CC (3232 patients), 3 studies of LD + AC versus LD (715 patients), and no studies of LD + AC versus CC. LD was more effective than CC in reducing leg pain (mean difference [MD] −10, P