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Endoscopic Transforaminal Discectomy for Recurrent Lumbar Disc Herniation: A Prospective, Cohort Evaluation of 262 Consecutive Cases

Hoogland, Thomas, MD, PhD; van den Brekel-Dijkstra, Karolien, MD, PhD; Schubert, Michael, MD; Miklitz, Boris, BSc

doi: 10.1097/BRS.0b013e31816c8ade
Clinical Case Series

Study Design. A prospective, cohort evaluation of 262 consecutive patients who underwent transforaminal endoscopic excision for recurrent lumbar disc herniation, after previous discectomy.

Objective. To review complications and results of the endoscopic transforaminal discectomy (ETD) for recurrent herniated disc with a 2-year follow-up.

Summary of Background Data. Recurrent herniation is a significant problem, as scar formation and progressive disc degeneration may lead to increased morbidity after traditional posterior reoperation. The studies published until now on recurrent disc herniation concern various operative techniques, mostly the lumbar microdiscectomy, which is still seen as the standard. The advantage of ETD could be that there is no need to go through the old scar tissue and the procedure can be performed in local anesthesia. The disadvantage may be a long learning curve for the surgeon.

Method. Between January 1994 and November 2002, 262 patients with primarily radicular problems underwent an ETD for a recurrent herniated disc. Two hundred and thirty-eight of these patients (90.84%) completed our 2-year follow-up questionnaire. Initial surgery of 82 patients was performed in-house, 180 external. Average age was 46.4 years. The female/male ratio was 29/71%.

Results. At 2-year follow-up 85.71% of patients rated the result of the surgery as excellent or good. 9.66% reported a fair and 4.62% patients an unsatisfactory result. Average improvement of back pain of 5.71 points and 5.85 points of leg pain on the VAS scale (1–10). According to Mac Nab, 30.67% of the patients felt fully regenerated, 50% felt their functional capacity to be slightly restricted, 16.81% felt their functional capacity noticeably restricted, and 2.52% felt unimproved or worse. All patients participated in a 3-month follow-up to establish the perioperative complications. The overall complication rate was 10/262 (3.8%), including 3 nerve root irritations and 7 early recurrent herniations (<3 month). There was no case of infection or discitis.

After 3 months and within 2 years, 4 patients have been treated for a recurrent herniated disc in our own center and 7 patients have been treated elsewhere, resulting in a recurrence rate 11/238 (4.62%).

Conclusion. ETD for recurrent disc herniation seems to be an effective method with few complications and a high patient satisfaction.

Endoscopic transforaminal discectomy (ETD) for recurrent disc herniation seems to be an effective method with few minor complications and a high patient satisfaction (86%).

From the Department of Spine Surgery, Alpha Klinik Munich, Germany.

Acknowledgment date: March 24, 2007. Revision date: November 6, 2007. Acceptance date: November 27, 2007.

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 and reprint requests to Dr. Thomas Hoogland, Department of Spine Surgery, Alpha Klinik Effnerstr. 38 81925 Munich; E-mail:

© 2008 Lippincott Williams & Wilkins, Inc.