EFFECTIVENESS OF PERCUTANEOUS ENDOSCOPIC TRANSFORAMINAL DISCECTOMY FOR RECURRENT LUMBAR DISC HERNIATION_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

LIZhuhai ,  ZENGJiancheng , SONGYueming , KONGQingquan , WANGXiandi , CHENGuo , NIEHongfei , JIANGHushan

Department of Orthopedic Surgery, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P. R. China;

Corresponding?author：

ZENGJiancheng, Email: tomzeng5@163.com

Keywords：

Recurrent lumbar disc herniation; Percutaneous endoscopic transforaminal discectomy; Transforaminal approach; Minimally invasive technique

DOI：

10.7507/1002-1892.20150011

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Objective To determine the feasibility and effectiveness of percutaneous endoscopic transforaminal discectomy (PETD) for recurrent lumbar disc herniation (RLDH). Methods Between June 2009 and December 2011, 56 patients with RLDH underwent PETD after local anesthesia, including 30 males and 26 females, with a mean age of 50 years (range, 24-70 years). The involved segments were L3, 4 in 3 cases, L4, 5 in 34 cases, and L5-S1 in 19 cases. Of 56 patients, 48 suffered from ipsilateral re-herniation, and 8 suffered from contralateral re-herniation. All the patients had a mean pain-free interval of 5.5 years (range, 6 months to 27 years). The visual analogue scale (VAS) score for back pain was 6.18±1.44 and the VAS score for leg pain was 7.66±1.03. Postoperative effectiveness was assessed based on the VAS score and modified MacNab criteria. Results The mean operation time was 60.4 minutes (range, 30-100 minutes) and the mean duration of hospital stay was 5.1 days (range, 3-6 days). All patients were followed up 28.2 months on average (range, 24-56 months). Patients obtained immediate pain relief postoperatively. The postoperative VAS scores of back and leg pain at 1 month, 3 months, 12 months, and last follow-up were significantly decreased when compared with preoperative score (P<0.05). Based on the modified MacNab criteria, the results were excellent in 39 cases, good in 9 cases, fair in 5 cases, and poor in 3 cases at 12 months after operation, and the excellent and good rate was 85.7%. Surgery-related complications were found in 5 cases (8.9%); one patient (1.8%) suffered from recurrence at 18 months postoperatively, and the symptom was relieved after open lumbar discectomy and intervertebral fusion surgery. Conclusion PETD has several advantages in treating RLDH, such as avoiding from the old scar tissue, decreasing operation-related complications, shortening operation time, reducing trauma, and obtaining rapid postoperative recovery. This technique is feasible and effective for RLDH.

Citation： LIZhuhai, ZENGJiancheng, SONGYueming, KONGQingquan, WANGXiandi, CHENGuo, NIEHongfei, JIANGHushan. EFFECTIVENESS OF PERCUTANEOUS ENDOSCOPIC TRANSFORAMINAL DISCECTOMY FOR RECURRENT LUMBAR DISC HERNIATION. Chinese Journal of Reparative and Reconstructive Surgery, 2015, 29(1): 43-47. doi: 10.7507/1002-1892.20150011 Copy

1.	Watters WC 3rd, McGirt MJ. An evidence-based review of the literature on the consequences of conservative versus aggressive discectomy for the treatment of primary disc herniation with radiculopathy. Spine J, 2009, 9(3):240-257.
2.	Aizawa T, Ozawa H, Kusakabe T, et al. Reoperation for recurrent lumbar disc herniation:a study over a 20-year period in a Japanese population. J Orthop Sci, 2012, 17(2):107-113.
3.	Gibson JN, Waddell G. Surgical interventions for lumbar disc prolapse:updated Cochrane Review. Spine (Phila Pa 1976), 2007, 32(16):1735-1747.
4.	Ruetten S, Komp M, Merk H, et al. Recurrent lumbar disc herniation after conventional discectomy:a prospective, randomized study comparing full-endoscopic interlaminar and transforaminal versus microsurgical revision. J Spinal Disord Tech, 2009, 22(2):122-129.
5.	Hoogland T, van den Brekel-Dijkstra K, Schubert M, et al. Endoscopic transforaminal discectomy for recurrent lumbar disc herniation:a prospective, cohort evaluation of 262 consecutive cases. Spine (Phila Pa 1976), 2008, 33(9):973-978.
6.	曾建成, 王賢帝, 宋躍明, 等. 經皮內鏡椎板間入路微創治療青少年腰椎間盤突出癥. 中國骨與關節雜志, 2013, 2(4):199-203.
7.	呂國華, 王冰, 劉偉東, 等. 完全內窺鏡下經椎板間入路手術治療腰椎間盤突出癥. 中國脊柱脊髓雜志, 2010, 20(6):448-452.
8.	Lee JK, Amorosa L, Cho SK, et al. Recurrent lumbar disk herniation. J Am Acad Orthop Surg, 2010, 18(6):327-337.
9.	Kim JM, Lee SH, Ahn Y, et al. Recurrence after successful percutaneous endoscopic lumbar discectomy. Minim Invasive Neurosurg, 2007, 50(2):82-85.
10.	Carragee EJ, Han MY, Suen PW, et al. Clinical outcomes after lumbar discectomy for sciatica:the effects of fragment type and anular competence. J Bone Joint Surg Am, 2003, 85-A(1):102-108.
11.	Meredith DS, Huang RC, Nguyen J, et al. Obesity increases the risk of recurrent herniated nucleus pulposus after lumbar microdiscectomy. Spine J, 2010, 10(7):575-580.
12.	Choi KB, Lee DY, Lee SH. Contralateral reherniation after open lumbar microdiscectomy:a comparison with ipsilateral reherniation. J Korean Neurosurg Soc, 2008, 44(5):320-326.
13.	Palma L, Carangelo B, Muzii VF, et al. Microsurgery for recurrent lumbar disk herniation at the same level and side:do patients fare worse? Experience with 95 consecutive cases. Surg Neurol, 2008, 70(6):619-621.
14.	Lee DY, Shim CS, Ahn Y, et al. Comparison of percutaneous endoscopic lumbar discectomy and open lumbar microdiscectomy for recurrent disc herniation. J Korean Neurosurg Soc, 2009, 46(6):515-521.
15.	Ahn Y, Lee SH, Park WM, et al. Percutaneous endoscopic lumbar discectomy for recurrent disc herniation:surgical technique, outcome, and prognostic factors of 43 consecutive cases. Spine (Phila Pa 1976), 2004, 29(16):E326-332.
16.	周躍, 李長青, 王建, 等. 經皮椎間孔成形術治療L5/S1神經根管狹窄癥. 中國脊柱脊髓雜志, 2009, 19(05):345-349.
17.	Osman SG, Nibu K, Panjabi MM, et al. Transforaminal and posterior decompressions of the lumbar spine. A comparative study of stability and intervertebral foramen area. Spine (Phila Pa 1976), 1997, 22(15):1690-1695.
18.	李振宙, 侯樹勛, 宋科冉, 等. 經椎板間隙入路完全內窺鏡下椎間摘除術治療L5/S1非包含型椎間盤突出癥. 中國脊柱脊髓雜志, 2013, 23(09):771-777.

1. Watters WC 3rd, McGirt MJ. An evidence-based review of the literature on the consequences of conservative versus aggressive discectomy for the treatment of primary disc herniation with radiculopathy. Spine J, 2009, 9(3):240-257.
2. Aizawa T, Ozawa H, Kusakabe T, et al. Reoperation for recurrent lumbar disc herniation:a study over a 20-year period in a Japanese population. J Orthop Sci, 2012, 17(2):107-113.
3. Gibson JN, Waddell G. Surgical interventions for lumbar disc prolapse:updated Cochrane Review. Spine (Phila Pa 1976), 2007, 32(16):1735-1747.
4. Ruetten S, Komp M, Merk H, et al. Recurrent lumbar disc herniation after conventional discectomy:a prospective, randomized study comparing full-endoscopic interlaminar and transforaminal versus microsurgical revision. J Spinal Disord Tech, 2009, 22(2):122-129.
5. Hoogland T, van den Brekel-Dijkstra K, Schubert M, et al. Endoscopic transforaminal discectomy for recurrent lumbar disc herniation:a prospective, cohort evaluation of 262 consecutive cases. Spine (Phila Pa 1976), 2008, 33(9):973-978.
6. 曾建成, 王賢帝, 宋躍明, 等. 經皮內鏡椎板間入路微創治療青少年腰椎間盤突出癥. 中國骨與關節雜志, 2013, 2(4):199-203.
7. 呂國華, 王冰, 劉偉東, 等. 完全內窺鏡下經椎板間入路手術治療腰椎間盤突出癥. 中國脊柱脊髓雜志, 2010, 20(6):448-452.
8. Lee JK, Amorosa L, Cho SK, et al. Recurrent lumbar disk herniation. J Am Acad Orthop Surg, 2010, 18(6):327-337.
9. Kim JM, Lee SH, Ahn Y, et al. Recurrence after successful percutaneous endoscopic lumbar discectomy. Minim Invasive Neurosurg, 2007, 50(2):82-85.
10. Carragee EJ, Han MY, Suen PW, et al. Clinical outcomes after lumbar discectomy for sciatica:the effects of fragment type and anular competence. J Bone Joint Surg Am, 2003, 85-A(1):102-108.
11. Meredith DS, Huang RC, Nguyen J, et al. Obesity increases the risk of recurrent herniated nucleus pulposus after lumbar microdiscectomy. Spine J, 2010, 10(7):575-580.
12. Choi KB, Lee DY, Lee SH. Contralateral reherniation after open lumbar microdiscectomy:a comparison with ipsilateral reherniation. J Korean Neurosurg Soc, 2008, 44(5):320-326.
13. Palma L, Carangelo B, Muzii VF, et al. Microsurgery for recurrent lumbar disk herniation at the same level and side:do patients fare worse? Experience with 95 consecutive cases. Surg Neurol, 2008, 70(6):619-621.
14. Lee DY, Shim CS, Ahn Y, et al. Comparison of percutaneous endoscopic lumbar discectomy and open lumbar microdiscectomy for recurrent disc herniation. J Korean Neurosurg Soc, 2009, 46(6):515-521.
15. Ahn Y, Lee SH, Park WM, et al. Percutaneous endoscopic lumbar discectomy for recurrent disc herniation:surgical technique, outcome, and prognostic factors of 43 consecutive cases. Spine (Phila Pa 1976), 2004, 29(16):E326-332.
16. 周躍, 李長青, 王建, 等. 經皮椎間孔成形術治療L5/S1神經根管狹窄癥. 中國脊柱脊髓雜志, 2009, 19(05):345-349.
17. Osman SG, Nibu K, Panjabi MM, et al. Transforaminal and posterior decompressions of the lumbar spine. A comparative study of stability and intervertebral foramen area. Spine (Phila Pa 1976), 1997, 22(15):1690-1695.
18. 李振宙, 侯樹勛, 宋科冉, 等. 經椎板間隙入路完全內窺鏡下椎間摘除術治療L5/S1非包含型椎間盤突出癥. 中國脊柱脊髓雜志, 2013, 23(09):771-777.

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Chinese Journal of Reparative and Reconstructive Surgery

EFFECTIVENESS OF PERCUTANEOUS ENDOSCOPIC TRANSFORAMINAL DISCECTOMY FOR RECURRENT LUMBAR DISC HERNIATION

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