Longitudinal clinical outcomes after full-endoscopic lumbar discectomy for recurrent disc herniation after open discectomy

Abstract Background: Percutaneous endoscopic lumbar discectomy (PELD) has become a feasible alternative to the conventional open surgery for the treatment of lumbar disc herniation (LDH), but PELD is associated with a certain rate of recurrence. Therefore, a good choice of surgical approach for recurrent lumbar disc herniation (rLDH) is important. The purpose of this study was to compare the outcomes between PELD and minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) for revision surgery for the rLDH after primary PELD surgery.Methods: This study retrospectively assessed 46 patients who suffered from rLDH after PELD surgery in Peking University First Hospital from January 2015 to June 2019, and patients were divided into two groups, PELD group (n=24) and MIS-TLIF group (n=22), according to different revision surgical methods. Preoperative data, perioperative conditions, complications, recurrence condition, and clinical outcomes were compared between these two groups.Results: Compared with the MIS-TLIF group, the PELD group was associated with shorter operative time, less intraoperative hemorrhage, and shorter post-operative hospitalization, but higher recurrence rate. Complication rates were comparable between two groups. Both the two groups could provide patients with satisfactory clinical outcomes at the 12-month follow-up after revision surgery. Compared with MIS-TLIF, PELD was associated with visual Analog Scale (VAS) scores of back pain, and Oswestry disability index (ODI) at the 1-month follow-up, whereas this effect was equalized after 6 months postoperatively.Conclusions: Either PELD or MIS-TLIF surgery could provide satisfactory clinical outcomes for revision surgery for the rLDH after primary PELD. PELD brought advantages in shorter operative time, less intraoperative hemorrhage, and shorter post-operative hospitalization over MIS-TLIF, however, higher postoperative recurrence rate of PELD couldn’t be ignored. Surgeons must weigh advantages against disadvantages of these surgical methods and fully informed patients preoperatively.

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Which clinical and radiological variables could predict clinical outcomes of percutaneous endoscopic lumbar discectomy for treatment of patients with lumbosacral disc herniation?

The Spine Journal ◽

10.1016/j.spinee.2017.12.010 ◽

2018 ◽

Vol 18 (8) ◽

pp. 1338-1346

Author(s):

Jung Hwan Lee ◽

Sang-Ho Lee

Keyword(s):

Clinical Outcomes ◽

Disc Herniation ◽

Lumbar Discectomy ◽

Percutaneous Endoscopic Lumbar Discectomy ◽

Endoscopic Lumbar Discectomy

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Recurrent disc herniation following percutaneous endoscopic lumbar discectomy preferentially occurs when Modic changes are present

10.21203/rs.2.19552/v1 ◽

2019 ◽

Author(s):

Lu Hao ◽

Shengwen Li ◽

Junhui Liu ◽

Zhi Shan ◽

Shunwu Fan ◽

...

Keyword(s):

Nucleus Pulposus ◽

Disc Herniation ◽

Hyaline Cartilage ◽

Modic Changes ◽

Lumbar Discectomy ◽

Herniated Disc ◽

Type I ◽

Percutaneous Endoscopic Lumbar Discectomy ◽

Recurrent Disc Herniation ◽

Endoscopic Lumbar Discectomy

Abstract Objective: To investigate the effect of Modic changes (MCs) and the herniated disc component on recurrent lumbar disc herniation (rLDH) following percutaneous endoscopic lumbar discectomy (PELD).Methods: We included 102 (65 males,37 females, aged 20–66 yr) inpatients who underwent PELD from August 2013 to August 2016. All patients underwent CT and MRI preoperative. The presence and type of Modic changes were assessed. During surgery the herniated disc component of each patient was classified into two groups: Nucleus pulposus group, Hyaline cartilage group. The association of herniated disc component with Modic changes was investigated. The incidence of recurrent disc herniation was assessed on more than 2-year follow-up.Results: In total, 11 patients were lost to follow up; the other 91 were followed up for 24–60 months. Of the 91 patients, 99 discs underwent PELD; 28/99 (28.3%) had MCs. Type I and II MCs were seen in 9 (9.1%) and 19 (19.2%), respectively; no type III MCs were found. Among 28 endplates with MCs, according to the herniated disc component, 18/28 (64.3%) showed evidence of hyaline cartilage in the intraoperative specimens, including 6/9 and 12/19 endplates with type I and II MCs, respectively. Among 71 endplates without MCs, 14/71 (19.7%) showed evidence of hyaline cartilage in the intraoperative specimens. Hyaline cartilage was more common in patients with MCs (P<0.05). We found 2 cases of rLDH in the non-MC group (n=71); 6 cases rLDH were found in the MC group (n=28), including 2 and 4 cases for types I and II, respectively. There was no significant difference between types I and II (P>0.05). rLDH was more common in patients with MCs (P<0.05). We found 5 rLDH cases in the hyaline cartilage group (n=32); 3 rLDH cases were found in the nucleus pulposus group (n=67). rLDH was more common in the hyaline cartilage group (P<0.05). Conclusions: MCs were associated with the herniated cartilage disc component. rLDH following PELD preferentially occurs when MCs or the herniated cartilage are present.

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