Surgical Strategy and Outcomes of Full Endoscopic Lumbar Discectomy for Recurrent Lumbar Disk Herniation Following a Previous Full Endoscopic Lumbar Discectomy

Abstract

ObjectiveRecurrent lumbar disc herniation (RLDH) cannot be prevented after full endoscopic lumbar discectomy (FELD), and the optimal surgical treatment for RLDH after FELD remains controversial. The aim of the study was to suggest a surgical strategy for FELD to treat RLDH following a previous FELD and to present surgical outcomes.MethodsBetween February 2015 and March 2022, 68 patients with RLDH were surgically treated with FELD retrospectively. An original approach was suggested for the treatment of early recurrence (24 h‐2 weeks). The full endoscopic transforaminal technique (FETD) was considered for patients requiring local anesthesia, and in RLDH with FETD indications or FEID technological difficulties. The full endoscopic interlaminar technique (FEID) was chosen in RLDH with FEID indications. Both FEID and FETD were suitable if no FEID or FETD technological difficulties existed. Clinical efficacy was evaluated using the visual analog scale (VAS) score, Oswestry disability index (ODI), and modified MacNab criteria. Postoperative follow‐up data at 24 h, 3 months, and final‐follow‐up were recorded. Operation time and clinical outcomes were assessed with t test. p‐value < 0.05 was considered statistically significant.ResultsAll 68 patients had an average follow‐up time of 23.8 months (range, 6–76 months). In the 13 cases of early recurrence, the operation time (32.30 ± 9.67 vs. 58.00 ± 6.16 min) in the original surgical approach group was shorter than that in the changing surgical approach group (p < 0.05). In the 28 cases of L4/5 FETD recurrence (>2 weeks), the operation time (66.17 ± 12.18 vs. 53.60 ± 5.45 min) in the FETD group was more than that in the FEID group (p < 0.05). In the 22 cases of L5S1 recurrence (>2 weeks), the operation time (55.75 ± 8.79 vs. 79.33 ± 6.65 min) in the FEID group was shorter than in the FETD group (p < 0.05). The postoperative VAS and ODI scores at 24 h, 3 months, and final‐follow up were all significantly improved, compared with their preoperative counterparts (p < 0.05). Based on the modified MacNab criteria, 88.23% of patients showed excellent or good results. Re‐recurrence occurred in three patients at 3 months. No surgical complications were observed in any of the 68 cases.ConclusionFELD is a safe and effective treatment option for RLDH with previous FELD. For early recurrence, the original approach was suggested. Both FEID and FETD were effective and safe for recurrence (>2 weeks), but FEID seemed more efficient for L4/5 RLDH after previous FETD and for L5S1 RLDH.

Endoscopic Revision Strategies and Outcomes for Recurrent L4/5 Disc Herniation After Percutaneous Endoscopic Transforaminal Discectomy

“…In addition to the surgical technique itself, scarring and adhesions have a significant impact on reoperation after PETD. 7 Therefore, when both surgeries are able to remove the herniated disc, PEID is preferred to avoid scarring, reduce the risk of nerve damage, and avoid intraoperative disorientation due to the lack of typical bony markings, and the procedure and difficulty are similar to the initial surgery. Earlier studies by Ruetten et al have confirmed this opinion.…”

“…For herniation with lateral recess stenosis: In Ahn’s study, 12 PETD was useful for recurrent disc herniation in selected cases, but was successful in only 33.3% of patients with concomitant lateral recess stenosis. While in FEID, the inner part of the articular process and the lower edge of the lamina can provide a relatively normal window to expose the nerve root and avoid being interfered with by scarring, 7 so that the herniation can be excised well after partial laminectomy is performed as needed ( Figure.4 ).

Figure 3 A 42-year-old female presented for the first time with “low back pain with pain in the left lower extremity”, and the lumbar MR showed a disc herniation at L45 (A) .

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