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

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

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, 王贤帝, 宋跃明, 等. 经皮内镜椎板间入路微创治疗青少年腰椎间盘突出症. 中国骨与关节杂志, 2013, 2(4):199-203.
7.	吕国华, 王冰, 刘伟东, 等. 完全内窥镜下经椎板间入路手术治疗腰椎间盘突出症. 中国脊柱脊髓杂志, 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.	周跃, 李长青, 王建, 等. 经皮椎间孔成形术治疗L5/S1神经根管狭窄症. 中国脊柱脊髓杂志, 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, 侯树勋, 宋科冉, 等. 经椎板间隙入路完全内窥镜下椎间摘除术治疗L5/S1非包含型椎间盘突出症. 中国脊柱脊髓杂志, 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, 王贤帝, 宋跃明, 等. 经皮内镜椎板间入路微创治疗青少年腰椎间盘突出症. 中国骨与关节杂志, 2013, 2(4):199-203.
7. 吕国华, 王冰, 刘伟东, 等. 完全内窥镜下经椎板间入路手术治疗腰椎间盘突出症. 中国脊柱脊髓杂志, 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. 周跃, 李长青, 王建, 等. 经皮椎间孔成形术治疗L5/S1神经根管狭窄症. 中国脊柱脊髓杂志, 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, 侯树勋, 宋科冉, 等. 经椎板间隙入路完全内窥镜下椎间摘除术治疗L5/S1非包含型椎间盘突出症. 中国脊柱脊髓杂志, 2013, 23(09):771-777.

Previous Article
SIGNIFICANCE OF CXCL-13 GENE EXPRESSION IN KNEE OSTEOARTHRITIS SYNOVIUM
Next Article
LOCATION CHANGE OF ROTATION CENTER AFTER SINGLE SEGMENTAL CERVICAL DISC REPLACEMENT WITH ProDisc-C

Chinese Journal of Reparative and Reconstructive Surgery

EFFECTIVENESS OF PERCUTANEOUS ENDOSCOPIC TRANSFORAMINAL DISCECTOMY FOR RECURRENT LUMBAR DISC HERNIATION

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content