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Percutaneous Endoscopic Lumbar Discectomy for Recurrent Disc Herniation: Surgical Technique, Outcome, and Prognostic Factors of 43 Consecutive Cases

Ahn, Yong, MD*; Lee, Sang-Ho, MD, PhD*; Park, Woo-Min, MD*; Lee, Ho-Yeon, MD, PhD*; Shin, Song-Woo, PhD*; Kang, Ho-Yeong, MD

doi: 10.1097/01.BRS.0000134591.32462.98
Clinical Case Series
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Study Design. A retrospective study of 43 consecutive patients who underwent percutaneous endoscopic lumbar discectomy for recurrent disc herniation.

Objectives. To evaluate the efficacy of endoscopic discectomy for recurrent disc herniations and to determine the prognostic factors affecting surgical outcome.

Summary of Background Data. Repeated open discectomy with or without fusion has been the most common procedure for a recurrent lumbar disc herniation. There have been no reports published on the feasibility and prognostic factors of the endoscopic discectomy for recurrent disc herniation.

Methods. The inclusion criteria were recurrent disc herniations at the same level, regardless of side, with a pain-free interval longer than 6 months after the conventional open discectomy. Posterolateral endoscopic laser-assisted disc excisions were performed under local anesthesia.

Results. The mean follow-up period was 31 months (24–39 months). Based on the MacNab criteria, 81.4% showed excellent or good outcomes. The mean visual analog scale decreased from 8.72 ± 1.20 to 2.58 ± 1.55 (P <0.0001). In our series, better outcomes were obtained in patients younger than 40 years (P = 0.035), patients with duration of symptoms of less than 3 months (P = 0.028), and patients without concurrent lateral recess stenosis (P = 0.007).

Conclusions. Percutaneous endoscopic lumbar discectomy is effective for recurrent disc herniation in selected cases. The posterolateral approach through unscarred virgin tissue can prevent nerve injury and could preserve the spinal stability. Both foraminal and intracanalicular portions can be decompressed simultaneously.

A retrospective study of 43 consecutive patients with recurrent lumbar disc herniations demonstrated that percutaneous endoscopic lumbar discectomy is effective in selected cases. Better outcomes were obtained in patients younger than 40 years, patients with duration of symptoms of less than 3 months, and patients without concurrent lateral recess stenosis.

From the Divisions of *Neurosurgery and †Diagnostic Radiology, Wooridul Spine Hospital, Seoul, Korea.

Acknowledgment date: June 19, 2003. First revision date: October 17,2003. Second revision date: November 10, 2003. Acceptance date: November 17, 2003.

The manuscript submitted does not contain information about medical device(s)/drug(s).

No funds were received in support of this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

Address correspondence to Yong Ahn, MD, Division of Neurosurgery, Wooridul Spine Hospital, 47-4 Chungdam-dong, Kangnam-gu, Seoul 135-100, Korea; E-mail: ns-ay@hanmail.net

© 2004 Lippincott Williams & Wilkins, Inc.