<p>Comparison of Percutaneous Endoscopic Lumbar Discectomy with Minimally Invasive Transforaminal Lumbar Interbody Fusion as a Revision Surgery for Recurrent Lumbar Disc Herniation after Percutaneous Endoscopic Lumbar Discectomy</p>

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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Clinical Outcomes of Lateral Lumbar Interbody Fusion Combined with Percutaneous Endoscopic Lumbar Discectomy During the Treatment of Low-grade Spondylolisthesis

10.21203/rs.3.rs-25405/v1 ◽

2020 ◽

Author(s):

Jiaqi Li ◽

Yapeng Sun ◽

Wei Zhang ◽

Fei Zhang ◽

Lei Guo ◽

...

Keyword(s):

Minimally Invasive ◽

Clinical Outcomes ◽

Interbody Fusion ◽

Lumbar Discectomy ◽

Low Grade ◽

Lumbar Interbody Fusion ◽

Percutaneous Endoscopic Lumbar Discectomy ◽

Lateral Lumbar Interbody Fusion ◽

Significant Difference ◽

Endoscopic Lumbar Discectomy

Abstract Background Minimally invasive lateral lumbar interbody fusion (LLIF) in combination with percutaneous endoscopic lumbar discectomy (PELD) can achieve interbody fusion and direct decompression, but their combined use has not been widely reported. In this study, the clinical outcomes of LLIF in combination with PELD in low-grade spondylolisthesis was evaluated, particularly in cases of a requirement for direct decompression. Methods Patients with single-level low-grade spondylolisthesis, undergoing LLIF in combination with PELD were included. The severity of lower back and leg pain was reported using visual analog scale (VAS). The Oswestry disability index (ODI) was used to evaluate functional improvements of patients. A comparison of preoperative and postoperative indicators was performed through repeated measures of analysis of variance. P < 0.05 was considered as a statistically significant difference. Results A total of 48 patients (20 males and 28 females) were included. The intraoperative blood loss was 112.60ml ± 43.69 and the average operation time was 116.35min ± 22.31. VAS and ODI were significantly improved in all stages after operation. The fusion rate at the final follow-up was 93.7%. No injuries occurred to the vessels, nerves and organs during the perioperative period. Conclusions LLIF in combination with PELD achieved adequate decompression and intervertebral fusion, with precise and reliable clinical outcomes. In addition, the procedure was minimally invasive, resulting in small tissue injury and rapid postoperative recovery. Multi-center prospective comparative studies are now needed to further confirm the superiority of this combination.

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