Revision for Endoscopic Diskectomy: Is Lateral Lumbar Interbody Fusion an Option?

Qiao, Guangxi; Feng, Min; Wang, Xiaodong; Liu, Jian; Ge, Miao; Yang, Bin; Yue, Bin

doi:10.1016/j.wneu.2019.07.226

Cited by 4 publications

(3 citation statements)

References 16 publications

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“…However, the patient populations of those studies were heterogeneous and included patients with adjacent-segment disease, 12,13 those requiring salvage for infection and pseudarthrosis, 11 and those with recurrent disc herniation after percutaneous endoscopic lumbar discectomy. 15 In this study, we applied strict inclusion criteria to elucidate the safety and efficacy of LLIF for revision interbody fusion, specifically at previously decompressed levels. This study is also unique in that we utilized PS to adjust the potential bias associated with the procedure selection.…”

Section: Discussionmentioning

confidence: 99%

Lateral lumbar interbody fusion in revision surgery for restenosis after posterior decompression

Kudo

Okano

Toyone

et al. 2020

Neurosurgical Focus

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OBJECTIVEThe purpose of this study was to compare the clinical results of revision interbody fusion surgery between lateral lumbar interbody fusion (LLIF) and posterior lumbar interbody fusion (PLIF) or transforaminal lumbar interbody fusion (TLIF) with propensity score (PS) adjustments and to investigate the efficacy of indirect decompression with LLIF in previously decompressed segments on the basis of radiological assessment.METHODSA retrospective study of patients who underwent revision surgery for recurrence of neurological symptoms after posterior decompression surgery was performed. Postoperative complications and operative factors were evaluated and compared between LLIF and PLIF/TLIF. Moreover, postoperative improvement in cross-sectional areas (CSAs) in the spinal canal and intervertebral foramen was evaluated in LLIF cases.RESULTSA total of 56 patients (21 and 35 cases of LLIF and PLIF/TLIF, respectively) were included. In the univariate analysis, the LLIF group had significantly more endplate injuries (p = 0.03) and neurological deficits (p = 0.042), whereas the PLIF/TLIF group demonstrated significantly more dural tears (p < 0.001), surgical site infections (SSIs) (p = 0.02), and estimated blood loss (EBL) (p < 0.001). After PS adjustments, the LLIF group still showed significantly more endplate injuries (p = 0.03), and the PLIF/TLIF group demonstrated significantly more dural tears (p < 0.001), EBL (p < 0.001), and operating time (p = 0.04). The PLIF/TLIF group showed a trend toward a higher incidence of SSI (p = 0.10). There was no statistically significant difference regarding improvement in the Japanese Orthopaedic Association scores between the 2 surgical procedures (p = 0.77). The CSAs in the spinal canal and foramen were both significantly improved (p < 0.001).CONCLUSIONSLLIF is a safe, effective, and less invasive procedure with acceptable complication rates for revision surgery for previously decompressed segments. Therefore, LLIF can be an alternative to PLIF/TLIF for restenosis after posterior decompression surgery.

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Section: Discussionmentioning

confidence: 99%

Lateral lumbar interbody fusion in revision surgery for restenosis after posterior decompression

Kudo

Okano

Toyone

et al. 2020

Neurosurgical Focus

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“…nonetheless, reported greater incidence of complications for rLDH. Qiao et al [21] Retrospective 47 Nearly 1 year Transforaminal lumbar interbody fusion Lateral Lumbar Interbody Fusion(LLIF) and Posterior lumbar interbody fusion, (PLIF) had comparable results Kapetanakis et al [22] Prospective 45 1 year Fully endoscopic lumbar discectomy With notable improvement rates for physical function, physical pain, and role-emotional factors, FELD is linked to a positive impact. Li et al [23] Prospective 73 4 years…”

Section: Satisfactory Resultsmentioning

confidence: 99%

Revision of Post-Endoscopic Discectomy: A Review

ALSHARAF,

Alsaif,

Sayed

2023

ijirms

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This review focuses on the recurrence of lumbar disc herniation after percutaneous endoscopic discectomy (PED) and the revision surgery options available for patients who require further treatment. PED is a minimally invasive surgical technique used to treat herniated discs in the lumbar spine. Although PED has many advantages over traditional open decompression and fusion surgery, recurrent herniation is a common complication that can lead to the need for revision surgery. It will provide insights into strategies for minimizing complications and improving outcomes of post-endoscopic revision discectomy. The goal is to assist clinicians in selecting the most appropriate revision surgery option for their patients based on individual risk factors and other relevant factors. Ultimately, the review aimed to improve patient outcomes and reduce the need for repeat surgery in cases of recurrent herniation following PED. Various surgical techniques have been described for revision procedures, including repeated endoscopic discectomy, open discectomy, minimally invasive microdiscectomy, and fusion. The choice of technique depends on the specific indications and individual patient characteristics. The review will discuss common options for revision surgery, including minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF), micro-endoscopic discectomy (MED), and PED. Factors that increase the risk of recurrence after primary PED surgery, such as advanced age, obesity, and Modic changes, will also be discussed. Further research and long-term follow-up studies are warranted to enhance our understanding of the optimal management strategies and outcomes of post-endoscopic discectomy revision.

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“…6 Given the almost universally poor results, open surgical intervention for epidural fibrosis has been discouraged. 6 Although earlier surgical interventions for recurrent radicular pain have focused on exploration of the prior surgical site via a repeat posterior approach using either open or minimally invasive techniques, [17][18][19] little evidence exists in the literature that spinal arthrodesis without direct decompression can accomplish relief of recurrent radiculopathy in the setting of an epidural scar. In the present study, we used lateral and anterior approaches for interbody fusion at the index level to address each patient's radicular symptomatology in the setting of epidural fibrosis.…”

Section: Discussion Observationsmentioning

confidence: 99%

Spinal arthrodesis via lumbar interbody fusion without direct decompression as a treatment for recurrent radicular pain due to epidural fibrosis: patient series

Swong¹,

Strong²,

Nathan³

et al. 2021

Journal of Neurosurgery: Case Lessons

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BACKGROUND Lumbar radiculopathy is the most common indication for lumbar discectomy, but residual postoperative radicular symptoms are common. Postoperative lumbar radiculopathy secondary to scar formation is notoriously difficult to manage, with the mainstay of treatment focused on nonoperative techniques. Surgical intervention for epidural fibrosis has shown unacceptably high complication rates and poor success rates. OBSERVATIONS Three patients underwent spinal arthrodesis without direct decompression for recurrent radiculopathy due to epidural fibrosis. Each patient previously underwent lumbar discectomy but subsequently developed recurrent radiculopathy. Imaging revealed no recurrent disc herniation, although it demonstrated extensive epidural fibrosis and scar in the region of the nerve root at the previous surgical site. Dynamic radiographs showed no instability. Two patients underwent lateral lumbar interbody fusion, and one patient underwent anterior lumbosacral interbody fusion. Each patient experienced resolution of radicular symptoms by the 1-year follow-up. Average EQ visual analog scale scores improved from 65 preoperatively to 78 postoperatively. LESSONS Spinal arthrodesis via lumbar interbody fusion, without direct decompression, may relieve pain in patients with recurrent radiculopathy due to epidural fibrosis, even in the absence of gross spinal instability.

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Revision for Endoscopic Diskectomy: Is Lateral Lumbar Interbody Fusion an Option?

Cited by 4 publications

References 16 publications

Lateral lumbar interbody fusion in revision surgery for restenosis after posterior decompression

Lateral lumbar interbody fusion in revision surgery for restenosis after posterior decompression

Revision of Post-Endoscopic Discectomy: A Review

Spinal arthrodesis via lumbar interbody fusion without direct decompression as a treatment for recurrent radicular pain due to epidural fibrosis: patient series

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