Postoperative Longitudinal Outcomes in Patients with Residual Disc Fragments after Percutaneous Endoscopic Lumbar
Jonghyuk Baek1, Seung Heon Yang2, Chi Heon Kim3
1Department of Medicine, Seoul National University College of Medicine, South Korea.
Background:
Residual disc fragments are observed on immediate postoperative magnetic resonance imaging (MRI) in 2.8-15% of patients after percutaneous endoscopic lumbar discectomy (PELD). Considering the known postoperative longitudinal outcomes in patients with residual disc tissue, a 'watchful waiting' strategy may be preferable to immediate re-operation in patients with asymptomatic residual disc material.
Objectives:
The aim of the present study was to compare the longitudinal clinical outcomes between PELD patients in whom the complete removal of disc fragments was achieved (complete group) and those in whom residual disc fragments were observed on postoperative MRI (residual group).
Study Design:
Retrospective nested case-control study.
Methods:
A total of 225 patients were included (complete group, n=187 and residual group, n=38). Clinical assessments were performed using the visual analog pain score for the leg (VAS-L, x/10) and back (VAS-B, x/10) and the Korean version of the Oswestry Disability Index (K-ODI, x/45). A linear mixed-effects model was used to analyze changes during the first 24 postoperative months.
Results:
One month after surgery, significant improvements in the VAS-L, VAS-B and K-ODI values were observed and were maintained during the first 24 postoperative months. No differences in these changes were noted between the groups. Early re-operation (during the first 3 postoperative months) was performed in 3 patients in the residual group (7.9%) and in 4 patients in the complete group (2.1%) (P = 0.10).
Limitations:
First, the study design was retrospective. Moreover, the number of patients was relatively small and therefore insufficient to achieve robust statistical power. Second, we did not explore the radiological outcomes in patients with asymptomatic residual disc material because follow-up MRI was only obtained to document symptom recurrence.
Conclusion:
When residual disc tissue is observed in asymptomatic patients, a 'watchful waiting' strategy may be preferable to immediate re-operation. However, an increased early re-operation rate is expected for patients with residual disc tissue.
Key Words:
Discectomy, endoscopes, longitudinal studies, patient-reported outcome, percutaneous, reoperation, spine, residual disc.
Insights
Percutaneous endoscopic lumbar discectomy (PELD) patients with residual disc fragments showed similar longitudinal outcomes to those with complete removal. A watchful waiting strategy may be suitable for asymptomatic residual disc tissue, despite a potential increase in early re-operation rates.
Area of Science:
- Spine surgery
- Minimally invasive procedures
- Clinical outcomes research
Background:
- Residual disc fragments after percutaneous endoscopic lumbar discectomy (PELD) occur in 2.8-15% of patients.
- A 'watchful waiting' approach may be preferable for asymptomatic residual disc material over immediate re-operation.
Purpose of the Study:
- To compare longitudinal clinical outcomes between PELD patients with complete disc fragment removal and those with residual disc fragments.
- To evaluate the efficacy of PELD in achieving favorable patient-reported outcomes.
Main Methods:
- Retrospective nested case-control study involving 225 patients (187 complete, 38 residual).
- Clinical outcomes assessed using visual analog pain scores (VAS-L, VAS-B) and Oswestry Disability Index (K-ODI).
- Linear mixed-effects model analyzed changes over 24 postoperative months.
Main Results:
- Significant improvements in VAS-L, VAS-B, and K-ODI were observed one month post-surgery and maintained for 24 months.
- No significant differences in clinical outcome changes were noted between the complete and residual disc fragment groups.
- Early re-operation rates were 7.9% in the residual group versus 2.1% in the complete group (P=0.10).
Conclusions:
- Longitudinal clinical outcomes are comparable between PELD patients with and without residual disc fragments.
- A 'watchful waiting' strategy is a viable option for asymptomatic residual disc tissue.
- Patients with residual disc tissue may experience a slightly higher rate of early re-operation.
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