Longitudinal clinical outcomes after full-endoscopic lumbar discectomy for recurrent disc herniation after open discectomy

Optimal approach for total endoscopic discectomy and its effect on lumbar and leg function in patients with disc herniation

BACKGROUND

Disc herniation (DH) is a fragment of the disc nucleus that is pushed out of the annulus into the spinal canal due to a tear or rupture in the annulus. It is a common cause of lumbar and leg pains. Substantial advancements have been made to determine the cause of DH and to ensure accurate diagnosis, imaging, and treatment of this condition. Total endoscopic discectomy is an alternative surgical technique that is less invasive.

AIM

To study the optimal approach for a total endoscopic discectomy and its influence on lumbar and leg function in DH patients.

METHODS

This prospective study enrolled 120 patients with lumbar DH who were treated in our hospital from February 2018 to January 2021. All patients were randomly divided into the following two groups: The observation group, comprising 62 patients who underwent surgery using the interlaminar approach, and the control group, comprising 58 patients who were operated through the foramina approach. The treatment effects, perioperative indicators, functional recovery, pain, and quality of life were compared between the two groups.

RESULTS

The treatment effect in the observation group (93.55%) was significantly better than that in the control group (77.59%). There was no difference in the operative time and intraoperative blood loss amount between the two groups (P > 0.05). The hospitalization time of the observation group (4.34 ± 1.33 d) was significantly shorter than that of the control group (5.38 ± 1.57 days) (P < 0.05). The Japanese Orthopaedic Association and Oswestry Disability Index scores decreased significantly in both groups after treatment, but the scores were lower in the observation group than in the control group. The visual analog scale scores of the lower back and legs of the two groups were significantly reduced after treatment, but scores were lower in the observation group (2.18 ± 0.88 in the lower back and 1.42 ± 0.50 in the leg) than in the control group (3.53 ± 0.50 in the lower back and 2.21 ± 0.52 in the leg). A short form of the Arthritis Impact Measurement Scales 2 measurement scale (AIMS2-SF) score and Barthel index of the lower back of the two groups increased significantly after treatment, with the observation group having a significantly higher AIMS2-SF score (95.16 ± 1.74) and Barthel index (97.29 ± 1.75) than the control group (84.95 ± 2.14 and 89.16 ± 2.71, respectively) (P < 0.05).

CONCLUSION

Through total endoscopic discectomy with the interlaminar approach, the degree of pain in the waist and leg was reduced, and the lumbar function considerably recovered.

Percutaneous Endoscopic Lumbar Discectomy for Recurrent Lumbar Disc Herniation: An Updated Systematic Review and Meta-Analysis

OBJECTIVE

This meta-analysis evaluated surgical outcomes following endoscopic or conventional discectomy for recurrent lumbar disc herniation.

METHODS

Medline, Cochrane, EMBASE, and Google Scholar were search until October 16, 2016 using these terms: recurrent lumbar disc herniation, endoscopic surgery, and discectomy. Randomized controlled trials (RCTs), prospective, retrospective, and cohort studies were eligible for inclusion. Pooled difference in mean (PDM) with 95% confidence interval (CIs) or relative risks (RRs) were calculated using fixed-effects methods.

RESULTS

One RCT and 15 studies were included with a total of 820 patients. Patients received endoscopic surgery experienced shorter operation time than those received conventional surgery (PDM: -52.01, 95% CI: -76.84 to -27.18, P < 0.001). A significantly lower risk in complication was displayed in patients received endoscopic surgery compared to those received conventional surgery (RR: 0.209, 95% CI: 0.076-0.581, P = 0.003). No significant difference in the improvement in VAS (PDM: -2.19, 95% CI: -5.78 to 1.39, P = 0.231), length of stay (PDM: -6.44, 95% CI: -13.76 to 0.89, P = 0.085) and re-recurrence rate (PDM: 0.88, 95% CI: 0.22-3.50, P = 0.861) between groups.

CONCLUSIONS

Endoscopic and conventional discectomy reduced patient pain comparably, but endoscopic discectomy had significantly lower operation time and lower risk in complications, which may impact other outcomes such as recovery and healthcare costs. More studies are needed to confirm our findings.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s43465-022-00636-1.

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

Introduction

Revision surgery for recurrent lumbar disc herniation after surgical treatment is at times challenging due to epidural adhesions and scar. This study aimed to review the clinical results and safety of full-endoscopic lumbar discectomy via interlaminar (FELD-IL) and transforaminal (FELD-TF) approaches for revision surgery.

Methods

We conducted a retrospective study including 52 lumbar disc herniation revision patients (mean age, 51.8 years; male/female, 13/39), with 17 FELD-IL and 35 FELD-TF cases. Complication incidences were assessed by reviewing surgical videos and postoperative magnetic resonance images of nerve decompression outcomes. Patients' responses to Japan Orthopedic Association Back Pain Evaluation Questionnaire (JOABPEQ) and numerical rating scales (NRS) for lumbar pain, leg pain, and leg numbness were recorded before and during follow-up. The Wilcoxon-signed rank tests were utilized to compare pre- and postoperative group variables.

Results

The average operation time was 33.0 min in FELD-IL and 31.7 min in FELD-TF. Seven FELD-IL cases required lamina excavation with high-speed drill bars for scar tissue dissection from the lamina. Dura injury occurred during the excavation in one case. No complication was noted in the FELD-TF group. Successful decompression of the nerve was achieved in all cases. Complete sets of JOABPEQ and NRS were obtained in 64.5% of FELD-IL and in 82.9% of FELD-TF. The mean follow-up period was 18.6 months. All the subdomain of JOABPEQ and NRS improved significantly postoperative in both groups. There was no difference regarding the improvement of scores between the procedures except NRS for lumbar pain, which was more favorable in FELD-IL. Recurrence of herniation occurred in one patient (6%) after FELD-IL and two patients (6%) after FELD-TF.

Conclusions

Both FELD-IL and FELD-TF are safe and effective revision procedures for recurrent lumbar disc herniation. FELD-TF could be performed employing the same procedure as primary surgery in revisions, regardless of the previous surgical approach.