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SupplementaL Table 1. MEDLINE Search Strategy.*
Anatomic Search TermsLumbarLumbosacralDiagnostic Search TermsDis? herniationHerniationRadicul*SciaticaTherapeutic Search TermsACDAn?ular closureConservativeDis?ectomyFragmentectomyFragment excisionHerniotomyMicrodis?ectomyNonoperativeNonsurgicalNucleotomySequestrectomySubtotalSurg*Combination Search Termsor/1-2or/3-6or/7-20and/21-23* * represents wild-card truncation; ? represents wild-card substitution.
SupplementaL Table 2. Listing of Studies that were Excluded from Meta-analysis after Review of Full-text Manuscript.
StudyMain Reason for Study ExclusionAtlas, 1996 ADDIN EN.CITE ADDIN EN.CITE.DATA 34Redundant with Atlas, 2001 ADDIN EN.CITE Atlas200127827827817Atlas, S. J.Keller, R. B.Chang, Y.Deyo, R. A.Singer, D. E.General Medicine Division and the Medical Practices Evaluation Center, Massachusetts General Hospital, Harvard Medical School, Boston 02114, USA. satlas@partners.orgSurgical and nonsurgical management of sciatica secondary to a lumbar disc herniation: five-year outcomes from the Maine Lumbar Spine StudySpine (Phila Pa 1976)Spine (Phila Pa 1976)1179-872610AdultCohort StudiesDisabled PersonsFemaleFollow-Up StudiesHumansIntervertebral Disc Displacement/*complications/physiopathology/surgery*Lumbar VertebraeMaleMiddle AgedProspective StudiesSciatica/*etiology/*therapyTime FactorsTreatment OutcomeWorkers' Compensation2001May 150362-2436 (Print)
0362-2436 (Linking)11413434https://www.ncbi.nlm.nih.gov/pubmed/1141343425Barth, 2018 ADDIN EN.CITE ADDIN EN.CITE.DATA 35No surgical control groupBouma, 2013 ADDIN EN.CITE Bouma201355517Bouma, G. J.Barth, M.Ledic, D.Vilendecic, M.Department of Neurosurgery, Academic Medical Center, St. Lucas-Andreas Ziekenhuis, Jan Tooropstaat 164, 1061 AE, Amsterdam, The Netherlands. g.j.bouma@amc.uva.nlThe high-risk discectomy patient: prevention of reherniation in patients with large anular defects using an anular closure deviceEur Spine JEur Spine J1030-6225AdultBack Pain/etiology/*surgeryDiskectomy/instrumentation/*methodsFemaleHumansIntervertebral Disc Displacement/complications/*surgeryLumbar Vertebrae/*surgeryMaleMiddle AgedSecondary PreventionTreatment Outcome2013May1432-0932 (Electronic)
0940-6719 (Linking)23377540https://www.ncbi.nlm.nih.gov/pubmed/23377540PMC365706010.1007/s00586-013-2656-136No surgical control groupGerszten, 2010 ADDIN EN.CITE ADDIN EN.CITE.DATA 37Plasma disc decompression intervention groupHahn, 2014 ADDIN EN.CITE Hahn201411111117Hahn, B. S.Ji, G. Y.Moon, B.Shin, D. A.Ha, Y.Kim, K. N.Yoon do, H.Department of Neurosurgery, Spine and Spinal Cord Research Institute, Yonsei University College of Medicine, Seoul, Korea.Use of Annular Closure Device (Barricaid(R)) for Preventing Lumbar Disc Reherniation: One-Year Results of Three CasesKorean J NeurotraumaKorean J Neurotrauma119-22102DiskectomyIntervertebral disc degenerationLumbar vertebrae2014Oct2234-8999 (Print)
2234-8999 (Linking)27169045https://www.ncbi.nlm.nih.gov/pubmed/27169045PMC485260910.13004/kjnt.2014.10.2.11938No surgical control groupHou, 2012 ADDIN EN.CITE Hou201229629629617Hou, K.Liu, Z.Zhu, S.A long-term follow-up study of the remote result of lumbar discectomy versus conservative treatment for single-level lumbar disc herniationMedical Journal of Chinese People's Liberation ArmyMedical Journal of Chinese People's Liberation Army727-730379201239Non-English publicationKlassen, 2017 ADDIN EN.CITE ADDIN EN.CITE.DATA 40Redundant with Thome, 2018 ADDIN EN.CITE ADDIN EN.CITE.DATA 17Kursumovic, 2017 ADDIN EN.CITE Kursumovic201730630630617Kursumovic, A.Rath, S.Neurosurgery, Spinal Surgery, and Interventional Neuroradiology, Donauisar Klinikum Deggendorf.Performance of an Annular Closure Device in a 'Real-World', Heterogeneous, At-Risk, Lumbar Discectomy PopulationCureusCureuse1824911annular closureannular defectdiscdiscectomyherniationlimited discectomylumbarrecurrent herniationregistryreherniationsection.2017Nov 62168-8184 (Print)
2168-8184 (Linking)29321948https://www.ncbi.nlm.nih.gov/pubmed/29321948PMC575594510.7759/cureus.182441No surgical control groupLedic, 2015 ADDIN EN.CITE ADDIN EN.CITE.DATA 42No surgical control groupLequin, 2012 ADDIN EN.CITE Lequin201230730730717Lequin, M. B.Barth, M.Thome, C.Bouma, G. J.Department of Neurosurgery, Sint Lucas-Andreas Ziekenhuis and Academic Medical Center, Amsterdam, The Netherlands.
Department of Neurosurgery, University Hospital Mannheim, Mannheim, Germany.
Department of Neurosurgery, Medical University Innsbruck, Innsbruck, Austria.Primary limited lumbar discectomy with an annulus closure device: one-year clinical and radiographic results from a prospective, multi-center studyKorean J SpineKorean J Spine340-794Annulus closure deviceAnnulus fibrosusDisc herniationDiscectomy2012Dec1738-2262 (Print)
1738-2262 (Linking)25983843https://www.ncbi.nlm.nih.gov/pubmed/25983843PMC443056010.14245/kjs.2012.9.4.34043No surgical control groupLequin, 2013 ADDIN EN.CITE Lequin201328328328317Lequin, M. B.Verbaan, D.Jacobs, W. C.Brand, R.Bouma, G. J.Vandertop, W. P.Peul, W. C.Leiden-The Hague Spine Intervention Prognostic Study, GroupWilco, C. PeulBart, W. KoesRalph, T. W. M. ThomeerWilbert, B. van den HoutRonald, BrandDepartment of Neurosurgery, Academic Medical Center, Neurosurgical Center Amsterdam, Amsterdam, The Netherlands.Surgery versus prolonged conservative treatment for sciatica: 5-year results of a randomised controlled trialBMJ OpenBMJ Open35*Neurosurgery2013May 282044-6055 (Electronic)
2044-6055 (Linking)23793663https://www.ncbi.nlm.nih.gov/pubmed/23793663PMC365764910.1136/bmjopen-2012-00253444Redundant with Peul, 2008 ADDIN EN.CITE Peul200873737317Peul, W. C.van den Hout, W. B.Brand, R.Thomeer, R. T.Koes, B. W.Leiden-The Hague Spine Intervention Prognostic Study, GroupDepartment of Neurosurgery, Leiden University Medical Centre, PO Box 9600, 2300 RC Leiden, Netherlands. w.c.peul@lumc.nlProlonged conservative care versus early surgery in patients with sciatica caused by lumbar disc herniation: two year results of a randomised controlled trialBMJBMJ1355-83367657AdolescentAdultAgedDisabled PersonsHumansIntervertebral Disc Displacement/*surgeryMiddle AgedNetherlandsPain MeasurementProspective StudiesQuality-Adjusted Life YearsSciatica/*surgeryTreatment Outcome2008Jun 141756-1833 (Electronic)
0959-535X (Linking)18502911https://www.ncbi.nlm.nih.gov/pubmed/18502911PMC242707710.1136/bmj.a1437Malter, 1996 ADDIN EN.CITE Malter199628428428417Malter, A. D.Larson, E. B.Urban, N.Deyo, R. A.University of Washington School of Public Health, Seattle, USA.Cost-effectiveness of lumbar discectomy for the treatment of herniated intervertebral discSpine (Phila Pa 1976)Spine (Phila Pa 1976)1048-54; discussion 1055219Cost-Benefit AnalysisCosts and Cost AnalysisData Interpretation, StatisticalDiskectomy/*economicsFemaleHealth Maintenance Organizations/economicsHumansInsurance, Health, ReimbursementIntervertebral Disc Displacement/*surgeryLumbar Vertebrae/*surgeryMaleMiddle AgedQuality of LifeQuality-Adjusted Life YearsRisk ManagementTreatment Outcome1996May 10362-2436 (Print)
0362-2436 (Linking)8724089https://www.ncbi.nlm.nih.gov/pubmed/872408945Cost analysisNikoobakht, 2016 ADDIN EN.CITE ADDIN EN.CITE.DATA 46Plasma disc decompression intervention groupParker, 2013 ADDIN EN.CITE ADDIN EN.CITE.DATA 47Redundant with Parker, 2016 ADDIN EN.CITE Parker201688817Parker, S. L.Grahovac, G.Vukas, D.Vilendecic, M.Ledic, D.McGirt, M. J.Carragee, E. J.*Department of Neurosurgery, Vanderbilt University School of Medicine, Nashville, TN daggerDepartment of Neurosurgery, University Hospital Dubrava, Zagreb double daggerLocalitet Susak Neurosurgery, Rijeka, Croatia section signDepartment of Orthopedics, Stanford University, Stanford, CA.Effect of an Annular Closure Device (Barricaid) on Same-Level Recurrent Disk Herniation and Disk Height Loss After Primary Lumbar Discectomy: Two-year Results of a Multicenter Prospective Cohort StudyClin Spine SurgClin Spine Surg454-46029102016Dec2380-0194 (Electronic)
2380-0186 (Linking)27879508https://www.ncbi.nlm.nih.gov/pubmed/2787950810.1097/BSD.0b013e3182956ec516Peul, 2007 ADDIN EN.CITE ADDIN EN.CITE.DATA 6Redundant with Peul, 2008 ADDIN EN.CITE Peul200873737317Peul, W. C.van den Hout, W. B.Brand, R.Thomeer, R. T.Koes, B. W.Leiden-The Hague Spine Intervention Prognostic Study, GroupDepartment of Neurosurgery, Leiden University Medical Centre, PO Box 9600, 2300 RC Leiden, Netherlands. w.c.peul@lumc.nlProlonged conservative care versus early surgery in patients with sciatica caused by lumbar disc herniation: two year results of a randomised controlled trialBMJBMJ1355-83367657AdolescentAdultAgedDisabled PersonsHumansIntervertebral Disc Displacement/*surgeryMiddle AgedNetherlandsPain MeasurementProspective StudiesQuality-Adjusted Life YearsSciatica/*surgeryTreatment Outcome2008Jun 141756-1833 (Electronic)
0959-535X (Linking)18502911https://www.ncbi.nlm.nih.gov/pubmed/18502911PMC242707710.1136/bmj.a1437Peul, 2009 ADDIN EN.CITE ADDIN EN.CITE.DATA 48Redundant with Peul, 2008 ADDIN EN.CITE Peul200873737317Peul, W. C.van den Hout, W. B.Brand, R.Thomeer, R. T.Koes, B. W.Leiden-The Hague Spine Intervention Prognostic Study, GroupDepartment of Neurosurgery, Leiden University Medical Centre, PO Box 9600, 2300 RC Leiden, Netherlands. w.c.peul@lumc.nlProlonged conservative care versus early surgery in patients with sciatica caused by lumbar disc herniation: two year results of a randomised controlled trialBMJBMJ1355-83367657AdolescentAdultAgedDisabled PersonsHumansIntervertebral Disc Displacement/*surgeryMiddle AgedNetherlandsPain MeasurementProspective StudiesQuality-Adjusted Life YearsSciatica/*surgeryTreatment Outcome2008Jun 141756-1833 (Electronic)
0959-535X (Linking)18502911https://www.ncbi.nlm.nih.gov/pubmed/18502911PMC242707710.1136/bmj.a1437Tosteson, 2008 ADDIN EN.CITE Tosteson200828928928917Tosteson, A. N.Skinner, J. S.Tosteson, T. D.Lurie, J. D.Andersson, G. B.Berven, S.Grove, M. R.Hanscom, B.Blood, E. A.Weinstein, J. N.Dartmouth Medical School, Hanover, NH 03756, USA. anna.tosteson@ dartmouth.eduThe cost effectiveness of surgical versus nonoperative treatment for lumbar disc herniation over two years: evidence from the Spine Patient Outcomes Research Trial (SPORT)Spine (Phila Pa 1976)Spine (Phila Pa 1976)2108-153319AdultCost-Benefit AnalysisFemale*Health Care CostsHumansIntervertebral Disc Displacement/pathology/physiopathology/*therapyLaminectomy/*economicsLumbar Vertebrae/pathology/*surgeryMaleModels, Econometric*Orthotic Devices*Physical Therapy ModalitiesQuality of Life2008Sep 11528-1159 (Electronic)
0362-2436 (Linking)18777603https://www.ncbi.nlm.nih.gov/pubmed/18777603PMC288377549Cost analysisTrummer, 2013 ADDIN EN.CITE ADDIN EN.CITE.DATA 50No surgical control groupVeihelmann, 2006 ADDIN EN.CITE ADDIN EN.CITE.DATA 51Epidural neuroplasty intervention groupWeinstein, 2008 ADDIN EN.CITE ADDIN EN.CITE.DATA 52Redundant with Weinstein, 2006a ADDIN EN.CITE ADDIN EN.CITE.DATA 8 and Weinstein, 2006b ADDIN EN.CITE ADDIN EN.CITE.DATA 33Zhang, 2005 ADDIN EN.CITE Zhang200529729729717Zhang, N.Zhou, Y.Chu, T.Hao, Y.Prospective and comparative study of nucleoplasty and conservative treatment for lumbar disc herniationChinese Journal of Spine and Spinal CordChinese Journal of Spine and Spinal Cord722-7251512200553Non-English publicationZou, 2009 ADDIN EN.CITE Zou200929829829817Zou, J.W.Comparison of conservative treatment versus minimally invasive surgery for lumbar disk herniationJilin Journal of Traditional Chinese Medicine Jilin Journal of Traditional Chinese Medicine608-60929200954Non-English publication
SUPPLEMENTAL TABLE 3. Reporting of Main Outcomes Among Studies.
StudyPatient-reported OutcomesClinical OutcomesFollow-up at Data Extraction
(mo)Leg
PainBack
PainDisabilityFollow-up
at Data
Extraction
(mo)ReherniationReoperationLD+AC vs. LDBarth, 2016 ADDIN EN.CITE ADDIN EN.CITE.DATA 1524XXX24XXParker, 2016 ADDIN EN.CITE Parker201688817Parker, S. L.Grahovac, G.Vukas, D.Vilendecic, M.Ledic, D.McGirt, M. J.Carragee, E. J.*Department of Neurosurgery, Vanderbilt University School of Medicine, Nashville, TN daggerDepartment of Neurosurgery, University Hospital Dubrava, Zagreb double daggerLocalitet Susak Neurosurgery, Rijeka, Croatia section signDepartment of Orthopedics, Stanford University, Stanford, CA.Effect of an Annular Closure Device (Barricaid) on Same-Level Recurrent Disk Herniation and Disk Height Loss After Primary Lumbar Discectomy: Two-year Results of a Multicenter Prospective Cohort StudyClin Spine SurgClin Spine Surg454-46029102016Dec2380-0194 (Electronic)
2380-0186 (Linking)27879508https://www.ncbi.nlm.nih.gov/pubmed/2787950810.1097/BSD.0b013e3182956ec51624XXX24XXThome, 2018 ADDIN EN.CITE ADDIN EN.CITE.DATA 1724XXX24XXLD vs. CCAtlas, 2001 ADDIN EN.CITE Atlas200127827827817Atlas, S. J.Keller, R. B.Chang, Y.Deyo, R. A.Singer, D. E.General Medicine Division and the Medical Practices Evaluation Center, Massachusetts General Hospital, Harvard Medical School, Boston 02114, USA. satlas@partners.orgSurgical and nonsurgical management of sciatica secondary to a lumbar disc herniation: five-year outcomes from the Maine Lumbar Spine StudySpine (Phila Pa 1976)Spine (Phila Pa 1976)1179-872610AdultCohort StudiesDisabled PersonsFemaleFollow-Up StudiesHumansIntervertebral Disc Displacement/*complications/physiopathology/surgery*Lumbar VertebraeMaleMiddle AgedProspective StudiesSciatica/*etiology/*therapyTime FactorsTreatment OutcomeWorkers' Compensation2001May 150362-2436 (Print)
0362-2436 (Linking)11413434https://www.ncbi.nlm.nih.gov/pubmed/114134342560XXX60XButtermann, 2004 ADDIN EN.CITE Buttermann200427927927917Buttermann, G. R.Midwest Spine Institute, 1950 Curve Crest Boulevard, Stillwater, MN 55082.Treatment of lumbar disc herniation: epidural steroid injection compared with discectomy. A prospective, randomized studyJ Bone Joint Surg AmJ Bone Joint Surg Am670-986-A4Adrenal Cortex Hormones/administration & dosageAdultAnti-Inflammatory Agents/administration & dosageDiskectomy/methodsHumansInjections, EpiduralIntervertebral Disc Displacement/*drug therapy/*surgery*Lumbar VertebraeNeurologic ExaminationProspective StudiesTreatment Outcome2004Apr0021-9355 (Print)
0021-9355 (Linking)15069129https://www.ncbi.nlm.nih.gov/pubmed/150691292624XXX36XErginousakis, 2011 ADDIN EN.CITE ADDIN EN.CITE.DATA 2724XGugliotta, 2016 ADDIN EN.CITE ADDIN EN.CITE.DATA 2824XXXMcMorland, 2010 ADDIN EN.CITE ADDIN EN.CITE.DATA 2924XX24Xsterman, 2006 ADDIN EN.CITE Osterman200675757517Osterman, H.Seitsalo, S.Karppinen, J.Malmivaara, A.Orton Orthopaedic Hospital of the Invalid Foundation, Helsinki, Finland. heikki.osterman@kolumbus.fiEffectiveness of microdiscectomy for lumbar disc herniation: a randomized controlled trial with 2 years of follow-upSpine (Phila Pa 1976)Spine (Phila Pa 1976)2409-143121AdultDiskectomy/*methodsFemaleFollow-Up StudiesHumansIntervertebral Disc Displacement/complications/pathology/*surgeryLumbar Vertebrae/pathology/*surgeryMaleMicrosurgery/*methodsMiddle AgedPain, Postoperative/etiologyProspective StudiesSciatica/etiology2006Oct 011528-1159 (Electronic)
0362-2436 (Linking)17023847https://www.ncbi.nlm.nih.gov/pubmed/1702384710.1097/01.brs.0000239178.08796.523024XXX24*XPeul, 2008 ADDIN EN.CITE Peul200873737317Peul, W. C.van den Hout, W. B.Brand, R.Thomeer, R. T.Koes, B. W.Leiden-The Hague Spine Intervention Prognostic Study, GroupDepartment of Neurosurgery, Leiden University Medical Centre, PO Box 9600, 2300 RC Leiden, Netherlands. w.c.peul@lumc.nlProlonged conservative care versus early surgery in patients with sciatica caused by lumbar disc herniation: two year results of a randomised controlled trialBMJBMJ1355-83367657AdolescentAdultAgedDisabled PersonsHumansIntervertebral Disc Displacement/*surgeryMiddle AgedNetherlandsPain MeasurementProspective StudiesQuality-Adjusted Life YearsSciatica/*surgeryTreatment Outcome2008Jun 141756-1833 (Electronic)
0959-535X (Linking)18502911https://www.ncbi.nlm.nih.gov/pubmed/18502911PMC242707710.1136/bmj.a143724XXX24XThomas, 2007 ADDIN EN.CITE Thomas200728828828817Thomas, K. C.Fisher, C. G.Boyd, M.Bishop, P.Wing, P.Dvorak, M. F.Department of Surgery (Orthopedics) and Neurosciences, University of Calgary, Calgary, AB, Canada.Outcome evaluation of surgical and nonsurgical management of lumbar disc protrusion causing radiculopathySpine (Phila Pa 1976)Spine (Phila Pa 1976)1414-223213AdultDisability EvaluationDiskectomy/methodsFemaleFollow-Up StudiesHumansIntervertebral Disc Displacement/complications/*surgery/*therapyLinear ModelsLumbar Vertebrae/*surgeryMaleMiddle AgedPain, PostoperativeProspective StudiesQuality of LifeRadiculopathy/etiology/*surgery/*therapyTreatment Outcome2007Jun 11528-1159 (Electronic)
0362-2436 (Linking)17545909https://www.ncbi.nlm.nih.gov/pubmed/1754590910.1097/BRS.0b013e318060a5d13112XXWeber, 1983 ADDIN EN.CITE Weber198329129129117Weber, H.Lumbar disc herniation. A controlled, prospective study with ten years of observationSpine (Phila Pa 1976)Spine (Phila Pa 1976)131-4082AdultFemaleHumansIntervertebral Disc Displacement/*surgeryLumbar Vertebrae/surgeryMaleMiddle AgedPhysical Therapy ModalitiesPostoperative Complications/etiologyPrognosisProspective StudiesRecurrenceSciatica/surgery1983Mar0362-2436 (Print)
0362-2436 (Linking)6857385https://www.ncbi.nlm.nih.gov/pubmed/68573853248XX48XWeinstein, 2006a ADDIN EN.CITE ADDIN EN.CITE.DATA 824XX24XWeinstein, 2006b ADDIN EN.CITE ADDIN EN.CITE.DATA 3324XX24XCC indicates conservative care; LD, lumbar discectomy; LD+AC, lumbar discectomy with bone-anchored annular closure
*Reherniation data not extracted for LD vs. CC comparisons since disc repair is not performed with CC and outcomes are rarely reported.
ref SHAPE \* MERGEFORMAT SUPPLEMENTAL FIGURE 1. Structure of Network Formed by Interventions and Their Comparisons.
Lumbar Discectomy
Lumbar Discectomy with Bone-anchored Annular Closure
Conservative Care
3 studies, 715 patients
11 studies,
3232 patients
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