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Published on: August 7, 2018
Repeated microendoscopic discectomy for recurrent lumbar disk herniation
Tianyong Hou1, Qiang Zhou1, Fei Dai1
1National & Regional United Engineering Lab of Tissue Engineering, Department of Orthopaedics, Southwest Hospital, the Third Military, Medical University, Chongqing, China.
Objectives:
To explore the microendoscopic discectomy technique and inclusion criteria for the treatment of recurrent lumbar disc herniation and to supply feasible criteria and technical notes to avoid complications and to increase the therapeutic effect.
Methods:
A consecutive series of 25 patients who underwent posterior microendoscopic discectomy for recurrent lumbar disc herniation were included. The inclusion criteria were as follows: no severe pain in the lumbar region, no lumbar instability observed by flexion-extension radiography and no intervertebral discitis or endplate damage observed by magnetic resonance imaging. All patients were diagnosed by clinical manifestations and imaging examinations.
Results:
Follow-up visits were carried out in all cases. Complications, such as nerve injuries, were not observed. The follow-up outcomes were graded using the MacNab criteria. A grade of excellent was given to 12 patients, good to 12 patients and fair to 1 patient. A grade of excellent or good occurred in 96% of cases. One patient relapsed 3 months after surgery and then underwent lumbar interbody fusion and inner fixation. The numerical rating scale of preoperative leg pain was 7.4 ± 1.5, whereas it decreased to 2.1 ± 0.8 at 7 days after surgery. The preoperative Oswestry disability index of lumbar function was 57.5 ± 10.0, whereas it was 26.0 ± 8.5 at 7 days after surgery.
Conclusion:
In these cases, microendoscopic discectomy was able to achieve satisfactory clinical results. Furthermore, it has advantages over other methods because of its smaller incision, reduced bleeding and more efficient recovery.
Insights
Microendoscopic discectomy offers a minimally invasive option for recurrent lumbar disc herniation, achieving excellent or good outcomes in 96% of patients with reduced complications and faster recovery.
Area of Science:
- Neurosurgery
- Minimally Invasive Spine Surgery
Background:
- Recurrent lumbar disc herniation presents challenges in treatment.
- Microendoscopic discectomy is an evolving technique for spinal conditions.
Purpose of the Study:
- To evaluate the efficacy and safety of microendoscopic discectomy for recurrent lumbar disc herniation.
- To define inclusion criteria and technical considerations for optimal outcomes.
Main Methods:
- Posterior microendoscopic discectomy was performed on 25 patients.
- Strict inclusion criteria excluded severe pain, instability, discitis, and endplate damage.
- Patients were diagnosed via clinical evaluation and imaging.
Main Results:
- 96% of patients achieved excellent or good outcomes (MacNab criteria).
- No nerve injuries or other complications were observed.
- Significant reductions in leg pain and disability index were noted post-surgery.
Conclusions:
- Microendoscopic discectomy is effective for recurrent lumbar disc herniation.
- The technique offers advantages including smaller incisions, less bleeding, and quicker recovery.
- Careful patient selection and technical execution are key to success.
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