Percutaneous endoscopic lumbar discectomy for recurrent disc herniation: surgical technique, outcome, and prognostic factors of 43 consecutive cases.
METHODS
A retrospective study of 43 consecutive patients who underwent percutaneous endoscopic lumbar discectomy for recurrent disc herniation.


OBJECTIVE
To evaluate the efficacy of endoscopic discectomy for recurrent disc herniations and to determine the prognostic factors affecting surgical outcome.


BACKGROUND
Repeated open discectomy with or without fusion has been the most common procedure for a recurrent lumbar disc herniation. There have been no reports published on the feasibility and prognostic factors of the endoscopic discectomy for recurrent disc herniation.


METHODS
The inclusion criteria were recurrent disc herniations at the same level, regardless of side, with a pain-free interval longer than 6 months after the conventional open discectomy. Posterolateral endoscopic laser-assisted disc excisions were performed under local anesthesia.


RESULTS
The mean follow-up period was 31 months (24-39 months). Based on the MacNab criteria, 81.4% showed excellent or good outcomes. The mean visual analog scale decreased from 8.72 +/- 1.20 to 2.58 +/- 1.55 (P <0.0001). In our series, better outcomes were obtained in patients younger than 40 years (P = 0.035), patients with duration of symptoms of less than 3 months (P = 0.028), and patients without concurrent lateral recess stenosis (P = 0.007).


CONCLUSIONS
Percutaneous endoscopic lumbar discectomy is effective for recurrent disc herniation in selected cases. The posterolateral approach through unscarred virgin tissue can prevent nerve injury and could preserve the spinal stability. Both foraminal and intracanalicular portions can be decompressed simultaneously.
Divisions of Neurosurgery, Wooridul Spine Hospital, Seoul, Korea. ns-ay@hanmail.net
Yong
Y
Ahn
Sang-Ho
SH
Lee
Woo-Min
WM
Park
Ho-Yeon
HY
Lee
Song-Woo
SW
Shin
Ho-Yeong
HY
Kang
D000328:Adult; D000368:Aged; D017587:Diskectomy, Percutaneous / Q000379:methods; D005260:Female; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000601:surgery*; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012008:Recurrence; D012189:Retrospective Studies; D016896:Treatment Outcome