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A Mobile Outside-in Technique of Transforaminal Lumbar Endoscopy for Lumbar Disc Herniations
Published on: August 7, 2018
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Radiologic and Patient-derived Predictors for Recurrent Lumbar Disc Herniation After Minimally Invasive Tubular
Paul C Emerson1, Samuel H Wakelin1, David Y Zhao2
1Georgetown University School of Medicine, Washington, District of Columbia, USA.
World Neurosurgery
|June 21, 2025
Summary
Recurrent lumbar disc herniation (rLDH) after minimally invasive discectomy occurs in 12.13% of cases. Modic endplate changes and subligamentous herniations are associated with increased rLDH risk, necessitating further research into predictive factors.
Area of Science:
- Neurosurgery
- Orthopedic Surgery
- Spinal Surgery
Background:
- Lumbar discectomy is a common treatment for radiculopathy caused by lumbar disc herniation (LDH).
- Recurrent LDH (rLDH) after initial surgery can lead to persistent symptoms and the need for reoperation.
- Reoperation for rLDH is associated with poorer patient outcomes.
Purpose of the Study:
- To identify risk factors associated with recurrent lumbar disc herniation (rLDH) after minimally invasive discectomy.
- To compare the recurrence rates of minimally invasive discectomy with traditional open microdiscectomy.
- To analyze the association between specific herniation subtypes and Modic endplate changes with rLDH.
Main Methods:
- Retrospective review of a prospectively collected database of 404 patients undergoing minimally invasive discectomy for LDH (2013-2020).
- Assessment of patient-derived factors (age, BMI, smoking, diabetes) and radiologic factors (disc height, Modic changes, herniation subtype).
- Herniation subtypes classified as protrusion, subligamentous extrusion, transligamentous extrusion, or sequestration; statistical analysis of recurrence incidence.
Main Results:
- The overall recurrence rate of rLDH after minimally invasive discectomy was 12.13%.
- Patients with recurrent LDH showed a higher prevalence of Modic endplate changes and a decreased prevalence of no Modic changes.
- An increased prevalence of subligamentous herniations and a decreased prevalence of transligamentous herniations were observed in the recurrence group.
Conclusions:
- Minimally invasive discectomy has comparable recurrence rates to open microdiscectomy for LDH.
- Modic endplate changes are a significant risk factor for recurrent lumbar disc herniation.
- Subligamentous herniation subtype may be associated with an increased risk of recurrence, though further investigation is warranted.
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