Risk Factors for Recurrent Disk Herniation After Biportal Endoscopic Diskectomy

This was a retrospective study.

The primary objective of this study was to analyze risk factor for recurrent disk herniation after biportal endoscopic diskectomy.

A total of 237 patients who underwent biportal endoscopic diskectomy for lumbar disk herniation were retrospectively reviewed. After exclusion criteria, the clinical and radiographic data of 160 patients were analyzed. Preoperative and postoperative visual analog score (VAS) and Oswestry Disability Index (ODI), preoperative demographic data, and radiological data were collected to assess for recurrent disk herniation risk factors.

Back VAS, leg VAS, and ODI showed improvement in symptoms at final follow-up (minimum 3 years). Fifteen patients were diagnosis with recurrent disk herniation. All 15 patients were symptom free for 6 months before recurrence of symptoms. Eight of 15 patients improved with conservative treatment, whereas the remaining underwent revision diskectomy by using the biportal endoscopic technique. Diabetes, smoking, and disk type (contained disk herniation) were risk factors of recurrent disk herniation after biportal endoscopic lumbar diskectomy (P < 0.05).

Single-level biportal endoscopic diskectomy showed good clinical outcomes similar to previous studies. Intermediate symptomatic recurrence rate was 9.4%, whereas only 5% required repeat surgery. Risk factors for recurrence was similar to open and tubular techniques. Despite the minimally invasiveness and high visualization capabilities of biportal endoscopy, patients who are diabetic, smoker, or contained disk herniation on MRI should be counseled for higher risk of recurrence.