Egyptian Spine Journal (Jan 2018)
A Consecutive Series of 39 Microendoscopic Discectomies for Recurrent Lumbar Disc Herniation
Abstract
Background Data: Interlaminar microendoscopic discectomy (MED) for treatment of primary lumbar disc herniation is a fairly established technique in clinical practice. However, in recurrent cases, a concern is raised that anatomy has been distorted thus endoscopic intervention may carry greater risks of morbidity. Purpose: In the present study, the authors report their seven years’ experience with posterior interlaminar MED in recurrent lumbar disc herniation (RLDH), highlighting the surgical technique, its outcome and feasibility. Study Design: A retrospective clinical case study. Patients and Methods: In the period between May, 2009 and July, 2016, 39 consecutive patients with symptomatic RLDH as confirmed by clinical examination, magnetic resonance imaging (MRI) and computed tomography (CT) scan underwent posterior interlaminar MED. Mean age was 39.7 years, range: (29-56 years). The approach was similar to a standard interlaminar MED. Patients were followed-up for 7 years (mean follow-up was 47.9 months, range: 3 – 83 months). Clinical outcomes were reviewed and evaluated in terms of pain Visual Analogue Scale (VAS) and Modified Macnab criteria (MMC). Results: Mean operative time was 97 minutes (range: 59–155 min.) with a mean blood loss of 57 ml and an approximate hospital stay of 22.5 hours. There were no new postoperative neurological deficits or major complications. At initial follow-up, according to MMC (3months postoperative) 67% of patients were pain free (26/39) and considered their postoperative status as excellent, 24% as good (9/39), and 8% (3/39) as fair, whereas one patient was unsatisfied. Intraoperatively, there were 3 patients of dural tears, mainly toward the beginning of our study, seven patients of accidental medial facetectomies due to excess bony work and two patients had an unintended fracture of the base of the spine. Postoperatively, 2 patients had temporary weakness of involved root that resolved on follow-up and three patients had transient postoperative neuralgia. Conclusion: Recurrent lumbar disc herniation can be treated safely and adequately with posterior interlaminar MED although of partial loss of anatomy. The technique is associated with satisfactory clinical results as well as short hospital stay. It provides adequate visualization and decompression of the involved nerve root. (2017ESJ127)
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