Comparison of percutaneous endoscopic lumbar discectomy and open lumbar microdiscectomy for recurrent disc herniation

Abstract

Objective: The purpose of this study was to compare clinical and radiological outcomes of percutaneous endoscopic lumbar discectomy (PELD) and open lumbar microdiscectomy (OLM) for recurrent disc herniation.

Methods: Fifty-four patients, who underwent surgery, either PELD (25 patients) or repeated OLM (29 patients), due to recurrent disc herniation at L4-5 level, were divided into two groups according to the surgical methods. Excluded were patients with sequestrated disc, calcified disc, severe neurological deficit, or instability. Clinical outcomes were assessed using Visual Analogue Scale (VAS) score and Oswestry Disability Index (ODI). Radiological variables were assessed using plain radiography and/or magnetic resonance imaging.

Results: Mean operating time and hospital stay were significantly shorter in PELD group (45.8 minutes and 0.9 day, respectively) than OLM group (73.8 minutes and 3.8 days, respectively) (p < 0.001). Complications occurred in 4% in PELD group and 10.3% in OLM group in the perioperative period. At a mean follow-up duration of 34.2 months, the mean improvements of back pain, leg pain, and functional improvement were 4.0, 5.5, and 40.9% for PELD group and 2.3, 5.1, and 45.0% for OLM group, respectively. Second recurrence occurred in 4% after PELD and 10.3% after OLM. Disc height did not change after PELD, but significantly decreased after OLM (p = 0.0001). Neither sagittal rotation angle nor volume of multifidus muscle changed significantly in both groups.

Conclusion: Both PELD and repeated OLM showed favorable outcomes for recurrent disc herniation, but PELD had advantages in terms of shorter operating time, hospital stay, and disc height preservation.

Keywords: Discectomy; Lumbar spine; Reherniation.

Fig. 1

The volume of multifidus muscle was measured on axial T2-weighted magnetic resonance imaging scan using a software system. After enlarging the axial slice of the lumbar spine, the cursor identified the area of the multifidus muscle, which the software calculated automatically.

Fig. 2

Schematic drawing showing percutaneous endoscopic lumbar discectomy (left) and repeated open lumbar microdiscectomy (right) for recurrent disc herniation.

Fig. 3

Upper : Intraoperative fluoroscopic images taken after insertion of endoscopic cannula. Middle : Recurrent disc herniation was removed with forceps under endoscopic view. Lower : Endoscopic view taken after successful removal of recurrent disc herniation.

Fig. 4

A : A plain radiograph taken 31 months after repeated open lumbar microdiscectomy for recurrent disc herniation at L4-5 level showing decrease of disc height at L4-5 level (left : preoperation, right : postoperation). B : A plain radiograph taken 34 months after percutaneous endoscopic lumbar discectomy for recurrent disc herniation at L4-5 level showing preserved disc height at L4-5 level (left : preoperation, right : postoperation).