title: Surgical outcome of percutaneous endoscopic interlaminar lumbar diskectomy for recurrent disk herniation after open diskectomy.
abstract: METHODS
  Technical report.
  
  
  OBJECTIVE
  To present a detailed surgical technique of percutaneous endoscopic interlaminar diskectomy (PEID) for recurrent lumbar disk herniation and present features of postoperative magnetic resonance images that were unavailable in previous studies.
  
  
  BACKGROUND
  Revision lumbar diskectomy is troublesome because of the difficulty in dissecting a surgical scar. Endoscopic diskectomy is regarded as an alternative method with comparable clinical outcome and less complication. Technically, a transforaminal approach is similar to a virgin operation, whereas an interlaminar approach is not, because of the scar tissue. There have been only 2 papers describing a PEID surgical procedure. Sharing details of the surgical technique is important in furthering the adoption of this technique, when it is indicated.
  
  
  METHODS
  We operated on 10 patients (M:F=6:4; mean age, 61.2±11.6 y) with PEID for recurrent lumbar disk herniation after open diskectomy. The level operated was L5-S1 in 5 cases, L4-5 in 4, and L2-3 in 1. During operation, we dissected the scar tissue from the medial facet joint with a working channel and removed the reherniated disk material after retraction of the scar tissue and the neural tissue together. Dissection of the scar tissue from the neural tissue was not attempted. The follow-up period was 14.4±9.9 months.
  
  
  RESULTS
  In all 10 patients, the reherniated disk materials were removed successfully. There was no incidence of dural tear. Postoperative magnetic resonance imaging showed good decompression with thecal sac reexpansion irrespective of the attached scar tissue, except in 1 patient. Excellent or good outcome by Macnab criteria was obtained in 6 of 10 patients, fair outcome in 2, and poor in 2 patients. Rerecurrence occurred in 1 patient 1 year after the surgery.
  
  
  CONCLUSIONS
  PEID with dissection of the scar tissue from the medial facet joint rather than from the neural tissue may be an effective alternative surgical method for recurrent disk herniation.
authors: Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea.
authors: Chi Heon
authors: CH
authors: Kim
authors: Chun Kee
authors: CK
authors: Chung
authors: Tae-Ahn
authors: TA
authors: Jahng
authors: Hee-Jin
authors: HJ
authors: Yang
authors: Young-Je
authors: YJ
authors: Son
mesh_terms: D000368:Aged; D000818:Animals; D002921:Cicatrix / Q000473:pathology / Q000601:surgery; D017586:Diskectomy / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D055111:Failed Back Surgery Syndrome / Q000473:pathology / Q000601:surgery*; D005260:Female; D006168:Guinea Pigs; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000473:pathology / Q000601:surgery*; D008159:Lumbar Vertebrae / Q000473:pathology / Q000601:surgery*; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D044583:Neuroendoscopy / Q000379:methods*; D017063:Outcome Assessment, Health Care / Q000379:methods; D011182:Postoperative Care / Q000379:methods; D011183:Postoperative Complications / Q000209:etiology / Q000473:pathology / Q000601:surgery; D012086:Reoperation / Q000379:methods; D012189:Retrospective Studies; D055502:Secondary Prevention; D055009:Spondylosis / Q000473:pathology / Q000601:surgery; D016896:Treatment Outcome