Abstract
Objective. The goal of the present study was to examine the clinical results of percutaneous endoscopic lumbar discectomy (PELD) and open lumbar surgery for patients with adjacent segment degeneration (ASD) and recurrence of disc herniation. Methods. From December 2011 to November 2013, we collected forty-three patients who underwent repeated lumbar surgery. These patients, either received PELD (18 patients) or repeated open lumbar surgery (25 patients), due to ASD or recurrence of disc herniation at L3-4, L4-5, or L5-S1 level, were assigned to different groups according to the surgical approaches. Clinical data were assessed and compared. Results. Mean blood loss was significantly less in the PELD group as compared to the open lumbar surgery group (P < 0.0001). Hospital stay and mean operating time were shorter significantly in the PELD group as compared to the open lumbar surgery group (P < 0.0001). Immediate postoperative pain improvement in VAS was 3.5 in the PELD group and −0.56 in the open lumbar surgery group (P < 0.0001). Conclusion. For ASD and recurrent lumbar disc herniation, PELD had more advantages over open lumbar surgery in terms of reduced blood loss, shorter hospital stay, operating time, fewer complications, and less postoperative discomfort.
Highlights
Adjacent segment degeneration (ASD) is not a rare condition nowadays due to the fact that spinal surgery is more widely performed
Recurrent disc herniation is thought to be the major cause of surgical failure after open lumbar surgery, especially after microdiscectomy procedure
The generally accepted surgical management for recurrence of lumbar herniated disc is repeated open lumbar surgery; approach associated complications attributed to tissue scarring and adjacent segment degeneration caused by further damage to the vertebral motion segments should be considered [3, 9,10,11]
Summary
Adjacent segment degeneration (ASD) is not a rare condition nowadays due to the fact that spinal surgery is more widely performed This condition is defined as the recurrence of symptoms associated with the degeneration at the free segment above a fusion after symptom-free period. The incidence of recurrent disc herniation has been reported to be around 5 to 18% in patients after open lumbar surgery [2,3,4,5,6,7,8]. The generally accepted surgical management for recurrence of lumbar herniated disc is repeated open lumbar surgery; approach associated complications attributed to tissue scarring and adjacent segment degeneration caused by further damage to the vertebral motion segments should be considered [3, 9,10,11]
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