Percutaneous discectomy: minimally invasive method for treatment of recurrent lumbar disc herniation.
OBJECTIVE
Recurrent lumbar disc herniation has been reported in 5-11% of patients. Revision surgery carries a higher risk of complications due to epidural scar formation and difficulty in identifying the bony landmarks. The present study was conducted to apply an innovative procedure which optimally has lower complications, and decrease the need for major surgery for high risk patients.


METHODS
Our study presents six patients of recurrent herniation after past performed procedures such as microdiscectomy, or a laminectomy and discectomy who were readmitted and treated with APLD (automated percutaneous lumbar discectomy) as the first line. The APLD criteria for patient selection in the present study are those with predominantly leg pain that failed conservative treatment for at least 6 weeks and, after lumbar surgery for at least 6 months at the same level.


RESULTS
Four of the patients have sciatica recovery signs ranging between excellent to good and, two showed no improvement. None of the screened patients in this study developed any serious complications.


CONCLUSIONS
Although this is a small series with a short follow up duration, it can be postulated that in the absence of objective evidence of spinal instability, recurrent disc herniation with predominantly leg pain may be treated by APLD as a first line. This can be especially helpful in patients with high risk for anesthesia.
Department of Neurosurgery, Jordan University of Science and Technology, Irbid, Jordan. heloqayli@yahoo.com
Haytham
H
Eloqayli
Mamoon
M
Al-omari
D000328:Adult; D017587:Diskectomy, Percutaneous / Q000379:methods*; D005260:Female; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000473:pathology / Q000601:surgery*; D007796:Laminectomy; D017116:Low Back Pain / Q000209:etiology; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D018908:Muscle Weakness / Q000209:etiology; D010147:Pain Measurement; D011391:Prolapse; D012008:Recurrence; D012585:Sciatica / Q000209:etiology; D016896:Treatment Outcome