Characteristics and Short-Term Surgical Outcomes of Patients with Recurrent Lumbar Disc Herniation after Percutaneous Laser Disc Decompression.

Hidetomi Terai,Nagakazu Shimada,Koji Tamai,Hiroshi Katsuda,Kunikazu Kaneda,Hiroaki Nakamura,Masayoshi Iwamae

doi:10.3390/medicina57111225

Hidetomi Terai, Nagakazu Shimada + Show 5 more

Open Access

https://doi.org/10.3390/medicina57111225

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Abstract

Background and Objectives: Although percutaneous laser disc decompression (PLDD) is one of the common treatment methods for patients with lumbar disc herniation (LDH), the recurrence of LDH after PLDD is estimated at 4–5%. This study compares the preoperative clinical data and clinical outcomes of patients who underwent primary microendoscopic discectomy (MED) or MED following PLDD. Materials and Methods: We retrospectively analyzed 2678 patients who underwent MED for LDH. The PLDD group included patients with previous PLDD history at the same level of LDH, and a matched control group was created using propensity score matching for age, sex, and body mass index. Preoperative data, preoperative radiographic findings, and surgical data of the groups were compared. To compare postoperative changes in clinical scores between the groups, a mixed-effect model was used. Results: As a result, 42 patients (1.6%) had previously undergone PLDD, and a control group with 42 patients were created. The disc degeneration severity was not significantly different between the groups. However, Modic changes were more frequent in the PLDD group than in the matched control group (p = 0.028). There were no significant differences in dural adhesion rate or surgery-related complications including dural injury, length of stay, and recurrence rate of LDH after surgery. In addition, the improvement of clinical scores did not significantly differ between the two groups (p = 0.112, 0.913, respectively). Conclusions: We concluded that patients with recurrent LDH after PLDD have advanced endplate degeneration, which may reflect endplate injury from a previous PLDD. However, a previous history of PLDD does not have a negative impact on the clinical result of MED.

Highlights

Lumbar disc herniation (LDH) is the most common cause of lumbosacral radicular syndrome and low back pain and affects 1–2% of the general population in the United States annually [1], placing a significant burden on healthcare services and the economy worldwide [2,3]
We hypothesize that the surgical outcomes of recurrent lumbar disc herniation (LDH) after percutaneous laser disc decompression (PLDD) are inferior to the outcomes of primary surgery due to nerve root and dural adhesion reflecting the inflammatory reaction of PLDD
Number Age Sex (Female/Male) Body weight Body height body mass index (BMI) Preop Japanese Orthopedic Association (JOA) score Preop Oswestry Disability Indexes (ODI) score p-value refers to the comparison between the severe and the no/mild numbness group. #: Mann–Whitney U test, †: Chi-squared test

Summary

Introduction

Lumbar disc herniation (LDH) is the most common cause of lumbosacral radicular syndrome and low back pain and affects 1–2% of the general population in the United States annually [1], placing a significant burden on healthcare services and the economy worldwide [2,3]. Open discectomy was used to treat patients with LDH; the incidence of low back pain following open discectomy surgery is almost 30% [5], and rates of revision surgery of up to 20% have been reported [6]. To overcome such disadvantages, minimally invasive decompression procedures including percutaneous laser disc decompression (PLDD) techniques have been developed [7]. It is well established that the clinical outcomes of reoperations for patients with recurrent LDH after open surgery are inferior to those of the primary surgery, with a higher incidence of complications after reoperations [10]. A previous history of PLDD does not have a negative impact on the clinical result of MED

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