Comparison of Three Minimally Invasive Spine Surgery Methods for Revision Surgery for Recurrent Herniation After Percutaneous Endoscopic Lumbar Discectomy.
BACKGROUND
Patients who experience a recurrence of percutaneous endoscopic lumbar discectomy (PELD) need to undergo revision surgery when they fail to respond to conservative therapy. Minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF), microendoscopic discectomy (MED), and PELD are 3 common minimally invasive surgical approaches for PELD recurrence. However, there have been no studies that have focused on the selection of the minimally invasive surgical method for PELD recurrence.


METHODS
Seventy-four patients who underwent revision surgery (MIS-TLIF, 26 cases; MED, 20 cases; PELD, 28 cases) for PELD recurrence were enrolled in this study. The preoperative characteristics and perioperative data were collected. Additionally, the clinical outcomes (visual analogue scale, Oswestry Disability Index, and the 12-item Short Form Health Survey) were collected and assessed at 1, 3, 6, 9, and 12 months postoperatively.


RESULTS
No significant differences in clinical outcomes over time were observed between these 3 surgical approaches. MED and PELD were associated with greater pain-relief effects at 1 month after surgery than MIS-TLIF, but this effect equalized at 3 months postoperatively. MED and PELD exhibited the advantages of reductions in operation time, blood loss, hospital stay and total cost compared to MIS-TLIF. However, MED and PELD also were significantly associated with greater recurrence rates than MIS-TLIF.


CONCLUSIONS
None of the three surgical approaches exhibited clear advantages in long-term pain or functional scores. MED and PELD were associated with lower costs and better perioperative effects than MIS-TLIF. However, compared with MIS-TLIF, the higher recurrence rates of MED and PELD should not be ignored.
Department of Orthopedics, Xinqiao Hospital, Third Military Medical University, Chongqing, China.
Yuan
Y
Yao
Department of Stomatology, the 457th Hospital of PLA, Wuhan, China.
Huiyu
H
Zhang
Department of Orthopedics, Xinqiao Hospital, Third Military Medical University, Chongqing, China.
Junlong
J
Wu
Department of Orthopedics, Xinqiao Hospital, Third Military Medical University, Chongqing, China.
Huan
H
Liu
Department of Orthopedics, Xinqiao Hospital, Third Military Medical University, Chongqing, China.
Zhengfeng
Z
Zhang
Department of Orthopedics, Xinqiao Hospital, Third Military Medical University, Chongqing, China. Electronic address: tangyu628@sina.com.
Yu
Y
Tang
Department of Orthopedics, Xinqiao Hospital, Third Military Medical University, Chongqing, China. Electronic address: happyzhou@vip.163.com.
Yue
Y
Zhou
D016063:Blood Loss, Surgical; D004185:Disability Evaluation; D017587:Diskectomy, Percutaneous / Q000191:economics; D004724:Endoscopy / Q000191:economics; D005260:Female; D017048:Health Care Costs; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000191:economics / Q000601:surgery*; D007902:Length of Stay / Q000191:economics; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D008866:Microsurgery / Q000191:economics; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000191:economics; D061646:Operative Time; D010147:Pain Measurement; D012008:Recurrence; D012086:Reoperation / Q000191:economics; D013123:Spinal Fusion; D013997:Time Factors; D016896:Treatment Outcome
Percutaneous endoscopic lumbar discectomy; Recurrent herniation; Revision surgery