Abstract
Full-endoscopic lumbar discectomy (FED) is one of the least invasive procedures for lumbar disc herniation. Patients who receive FED for lumbar disc herniation may develop recurrent herniation at a frequency similar to conventional procedures. Reoperation and risk factors of recurrent lumbar disc herniation were investigated among 909 patients who received FED using an interlaminar approach (FED-IL). Sixty-five of the 909 patients received reoperation for recurrent herniation. Disc height, smoking, diabetes mellitus (DM), subligamentous extrusion (SE) type, and Modic change were identified as the risk factors for recurrence. Other indicators such as LL, Cobb angle, disc migration, age, sex, and body mass index (BMI) did not reach significance. Among 65 patients, reoperation was performed within 14 days following FED-IL (very early) in 7 patients, from 15 days to 3 months (early) in 14 patients, from 3 months to 1 year (midterm) in 17 patients, and after more than 1 year (late) in 27 patients. The very early group included a greater number of males, and the mean age was significantly lower in comparison to other groups. All patients in the very early group received FED-IL for reoperation. Reoperation within 2 weeks allows FED-IL to be performed without adhesion. Fusion surgery was performed on three cases in the early and midterm groups and on 10 cases in the late group, which increased over time as degenerative change and adhesion progressed. The procedure selected to treat recurrent herniation mostly depends on the surgeon’s preference. Revision FED-IL is the first choice for recurrent herniation in terms of minimizing surgical burden, whereas fusion surgery offers the advantage that discectomy can be performed through unscarred tissues. FED-IL is recommended for recurrent herniation within 2 weeks before adhesion progresses.
Highlights
Introduction published maps and institutional affilPatients with lumbar disc herniation experience acute leg pain and disturbance in activities of daily living
No significant differences in sex or body mass index (BMI) were evident among subgroups, but mean age was significantly lower in the very early (VE) group (42.9 years) in comparison to the L group (54.1 years, p = 0.045) (Table 2)
full-endoscopic lumbar discectomy (FED)-IL was performed for all 7 cases in the VE group, 9 of 14 cases in the E group, 12 of 17 cases in the M group, and 15 of 27 cases in the L group, whereas fusion surgeries were performed on 0, 3, 3, and 10 cases, respectively (Table 2)
Summary
Patients with lumbar disc herniation experience acute leg pain and disturbance in activities of daily living. Conservative management, in the form of medication and rest, is generally the first choice for this pathology. Patients with intolerable pain for whom conservative treatment fails or who develop paralysis of limb muscles are considered for earlier surgical intervention. Patients who desire to return to work earlier are candidates for discectomy. Patients who have received surgery for lumbar disc herniation show greater improvement in function and satisfaction regarding treatment than non-surgically managed patients [1], so discectomy can be recommended. Several surgical options are available for lumbar disc herniation, including open microdiscectomy [2], microendoscopic discectomy [3], and full-endoscopic lumbar discectomy (FED) [4,5,6,7]
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