Full-Endoscopic Lumbar Discectomy for Recurrent Lumbar Disc Herniation: A Retrospective Study with Patient-Reported Outcome Measures

Yoshikane, Koichi; Kikuchi, Katsuhiko; Izumi, Toshihiro; Okazaki, Ken

doi:10.22603/ssrr.2020-0159

Cited by 10 publications

(7 citation statements)

References 21 publications

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“…In RLDH surgery, these adhesions increase the risk of injury to the dura and spinal nerves. The risk of durotomy ranges from 2% [ 17 ] to 16% [ 18 , 19 ]. This is similar to the findings in this retrospective review (16%).…”

Section: Discussionmentioning

confidence: 99%

Repeat Discectomy for the Management of Same-Level Recurrent Disc Herniation: A Study of 50 Patients

Musa,

Makirov,

Susin

et al. 2023

Cureus

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Background Same-level recurrent disc herniation remains a challenge in spine surgery. Although most surgeons agree on discectomy as the treatment of choice for primary lumbar disc herniation, the management of recurrent disc herniation remains ambiguous and largely depends on the operating surgeon. Many surgeons recommend repeat discectomy over fusion because it is cheaper and less invasive. In this study, we analyzed 50 patients who underwent a repeat discectomy. Materials and methods The patients in the study had previously been managed for lumbar disc herniation and then presented with either recurrent same-level herniation or symptoms attributed to the same level. The patients were then managed with a repeat discectomy without fusion. We analyzed the preoperative and postoperative Oswestry Disability Index (ODI), duration of surgery, blood loss, duration of hospitalization, and complications. Results Fifty patients were included: 27 females (54%), and 23 males (46%). They were followed up for an average of 2.81 years (range: 1-4). The mean duration of hospitalization was 4.06 ± 1.5 days (range: 2-8). The operative time was 104.60 minutes (range: 50-195), with an intraoperative blood loss of 85.40 mL (range: 50-150 mL). Durotomy occurred as a complication in eight (16%) patients. The recurrence rate was 26%, with 36% progressing to fusion. The change in preoperative ODI and postoperative ODI was 20.94 ± 7.24 (6-37), with a p-value of 0.04. There were no long-term complications recorded. Conclusion Repeat discectomy is a good management option for same-level recurrent disc herniation. The procedure is associated with low intraoperative blood loss and a short operating time, but there is a significant risk of durotomy. The risk of recurrence remains a concern due to the progression of degenerative changes, especially in the presence of Modic-2 changes. These advantages and disadvantages should be discussed with patients.

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Section: Discussionmentioning

confidence: 99%

Repeat Discectomy for the Management of Same-Level Recurrent Disc Herniation: A Study of 50 Patients

Musa,

Makirov,

Susin

et al. 2023

Cureus

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“…[4,5,8] ese repeat surgeries require variable operative times (i.e., range 29 min to 113.3 ± 45.44 min) usually incur significant additional risks due to scar, including intraoperative durotomy (2% [3] to 15%), and hemorrhage. [3,10] An estimated 25% of patient who present with recurrent discs already exhibit instability, warranting consideration of simultaneous fusion that could increase perioperative morbidity and costs. [4,7] CONCLUSION Recurrent lumbar disc herniations may be managed with repeat diskectomy without fusion.…”

Section: Discussionmentioning

confidence: 99%

Repeat discectomy for recurrent same level disc herniation: A literature review of the past 5 years

Musa

Barrientos

Макиров³

et al. 2023

Surgical Neurology International

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Background: Recurrent disc herniations remain a challenge in spinal surgery. Although some authors recommend a repeat discectomy, others offer more invasive secondary fusions. Here, we reviewed the literature (2017–2022) regarding the safety/efficacy of treating recurrent disc herniations with repeated discectomy alone. Methods: Our literature search of recurrent lumbar disc herniations included; Medline, PubMed, Google scholar, and the Cochrane database. We focused on the types of discectomy performed, perioperative morbidity, costs, length of surgery, pain scores, and incidence of secondary dural tears. Results: We identified 769 cases that included 126 microdiscectomies, and 643 endoscopic discectomies. Rates of disc recurrence ranged from 1% to 25% with accompanying secondary durotomy varying from 2% to 15%. In addition, operative times were relatively short, ranging from 29.2 min to 125 min, with a relatively small average estimated blood loss (i.e., minimal to maximally 150 mls). Conclusion: Repeated discectomy was the most commonly performed treatment for same-level recurrent disc herniations. Despite minimal intraoperative blood loss and short operating times, there was a significant risk of durotomy. Notably, patients must be informed that more extensive bone removal for treating recurrent disc increases the risk for instability warranting subsequent fusion.

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“…For ED, transforaminal approach is generally recommended over interlaminar approach because of a lesser risk of injury to nerve adhered to scar tissue. However, the indications of transforaminal approach are limited to bulging, subligamentous or transligamentous extruded disc herniation at disc level located L4/L5 or higher,[ 28 29 30 ] which may be responsible for a higher fraction of the spine surgeons preferring interlaminar approach over transforaminal approach (9.4% vs. 2.5%).…”

Section: Discussionmentioning

confidence: 99%

Endoscopic versus microscopic discectomy for pathologies of lumbar spine: A nationwide cross-sectional study from a lower-middle-income country

Pahwa,

Tayal,

Chowdhury

et al. 2023

Journal of Craniovertebral Junction and Spine

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Objective: We conducted a cross-sectional study to assess the preference of spine surgeons between MD for microdiscectomy and endoscopic discectomy (ED) surgery for the management of lumbar pathologies in a lower-middle-income country (LMIC). Methodology: An online survey assessing the preference of spine surgeons for various lumbar pathologies was developed and disseminated in “Neurosurgery Cocktail” a social media platform. Statistical analyses were performed using SPSS software with a level of significance <0.05. Results: We received responses from 160 spine surgeons having a median experience of 6.75 years (range 0–42 years) after residency. Most of the spine surgeons preferred MD over ED, preference being homogeneous across all lumbar pathologies. In ED, the interlaminar approach was preferred more frequently than the transforaminal approach. The most commonly chosen contraindication for the interlaminar approach and transforaminal approach was ≥ 3 levels lumbar disc herniation (LDH) (n = 117, 73.1%) and calcified LDH (n = 102, 63.8%), respectively. There was no significant association between the type of approach preferred (MD vs. ED; and interlaminar vs. translaminar endoscopic approach) with the type of workplace and the level of experience. Conclusion: Spine surgeons were inclined toward MD over ED, due to various reasons, such as a steep learning curve, lack of training opportunities, and upfront expenses. There is a pressing need for the upliftment of ED in LMICs which requires global action.

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Full-Endoscopic Lumbar Discectomy for Recurrent Lumbar Disc Herniation: A Retrospective Study with Patient-Reported Outcome Measures

Abstract: The institutional ethical review board of Kitakyushu Municipal Medical Center approved the study protocol (approve number: 202008002). Informed consent was obtained in the form of opt out on the website. All data were handled following the ethical standards of the Helsinki Declaration.

Cited by 10 publications

References 21 publications

Repeat Discectomy for the Management of Same-Level Recurrent Disc Herniation: A Study of 50 Patients

Repeat Discectomy for the Management of Same-Level Recurrent Disc Herniation: A Study of 50 Patients

Repeat discectomy for recurrent same level disc herniation: A literature review of the past 5 years

Endoscopic versus microscopic discectomy for pathologies of lumbar spine: A nationwide cross-sectional study from a lower-middle-income country

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