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Tubular Microdiscectomy for Recurrent Lumbar Disc Herniation: A Valuable Alternative to Endoscopic Techniques
Loïc de Nijs1, Edward Fomekong1, Christian Raftopoulos1
1Department of Neurosurgery, Saint-Luc Universitary Hospital, Brussels, Belgium.
Objective:
The efficacy of tubular microdiscectomy (TMD) in the treatment of recurrent lumbar disc herniation (rLDH) is still unclear, especially compared with the endoscopic technique. We performed a retrospective study to analyze this question.
Methods:
We retrospectively included all patients with an rLDH confirmed by magnetic resonance imaging who underwent TMD between January 2012 and February 2019. The general data included sex, age, body mass index, level of rLDH, first surgical approach, reoperation interval, occurrence of dural leak, re-recurrence, and re-reoperation. The clinical outcome was evaluated using a visual analog scale for leg pain, and the modified MacNab criteria were used to evaluate patient satisfaction.
Results:
The visual analog scale score for leg pain was statistically significantly reduced from 7.46 preoperatively to 0.80 postoperatively (P < 0.00001), and the patient satisfaction was good or excellent in 85.7% of cases, according to the modified MacNab criteria. Complications occurred in 3 of the 15 included patients: 2 dural tears (13.3%) and 2 re-recurrence (13.3%), but none of the patients underwent a third surgical procedure.
Conclusions:
TMD seems to be an efficient technique for the surgical treatment of leg pain caused by rLDH. In the literature, this technique seems to be at least as good as the endoscopic technique and is easier to master.
Insights
Tubular microdiscectomy (TMD) effectively treats recurrent lumbar disc herniation (rLDH), significantly reducing leg pain and achieving high patient satisfaction. This technique is comparable to endoscopic methods and easier to learn.
Area of Science:
- Neurosurgery
- Spinal Surgery
- Minimally Invasive Spine Surgery
Background:
- The effectiveness of tubular microdiscectomy (TMD) for recurrent lumbar disc herniation (rLDH) requires further clarification, particularly in comparison to endoscopic techniques.
- Recurrent lumbar disc herniation presents unique surgical challenges, necessitating evaluation of various treatment modalities.
Purpose of the Study:
- To evaluate the efficacy and outcomes of tubular microdiscectomy (TMD) in patients with recurrent lumbar disc herniation (rLDH).
- To compare the clinical results of TMD with existing literature on endoscopic techniques for rLDH.
Main Methods:
- A retrospective study included patients with rLDH who underwent TMD between January 2012 and February 2019.
- Clinical outcomes were assessed using the visual analog scale (VAS) for leg pain and the modified MacNab criteria for patient satisfaction.
- Complications such as dural tears and re-recurrence were recorded.
Main Results:
- TMD significantly reduced leg pain VAS scores from 7.46 preoperatively to 0.80 postoperatively (P < 0.00001).
- Good or excellent patient satisfaction was achieved in 85.7% of cases.
- Complications included dural tears (13.3%) and re-recurrence (13.3%), with no patients requiring a third surgery.
Conclusions:
- Tubular microdiscectomy (TMD) is an effective surgical option for managing leg pain associated with recurrent lumbar disc herniation (rLDH).
- The technique demonstrates comparable efficacy to endoscopic approaches and offers a potentially easier learning curve for surgeons.
