Recurrence after Successful Percutaneous Endoscopic Lumbar Discectomy

Abstract

The purpose of this study is to investigate the risk factors for recurrence after successful percutaneous endoscopic lumbar discectomy (PELD). Recently, PELD has become the most common surgical technique. However, there are only a few studies on the factors causing the reappearance of the symptoms. Between January 2002 and December 2004, 42 patients with recurrent disc herniation after successful PELD were classified as a recurrent group and 42 patients who underwent PELD with a satisfactory result were randomly selected for a non-recurrent group. For all the patients, we analyzed the medical records and radiological studies retrospectively. The patients' mean age was 47.4 years (range: 18-76) in the recurrent group, while the mean age of the non-recurrent group was 34.4 years (range: 17-66) (p=0.001). The body mass index was 24.9 in the recurrent group and 22.9 in the non-recurrent group (p=0.006). On the radiological studies, the protrusion (p=0.013) and the presence of Modic change (p=0.003) were more frequent in the recurrent group. For the successful PELD, it is desirable for the surgeon to consider the above risk factors carefully.

Key words

Successful PELD - recurrent disc herniation - Modic change - protrusion

References

• 1 Mixter WJ, Barr J. Rupture of the intervertebral disc with involvement of the spinal canal.  N Eng J Med. 1934;  211 210-215
• 2 Crock HV. Observation on the management of failed spinal operations.  J Bone Joint Surg [Br]. 1976;  58 193-199
• 3 Hermantin FU, Peters T, Quartararo L. et al . A prospective, randomized study comparing the results of open discectomy with those of video-assisted arthroscopic microdiscetomy.  J Bone Joint Surg [Am]. 1999;  81 958-965
• 4 Yeung AT, Tsou PM. Posterolateral endoscopic excision for lumbar disc herniation: surgical technique, outcome, and complication in 307 consecutive cases.  Spine. 2002;  27 722-231
• 5 Yeung AT. The evolution of percutaneous spinal endoscopy and discectomy: state of the art.  Mt Sinai J Med. 2000;  67 327-332
• 6 Knight MT, Vajda A, Jakab GV. et al . Endoscopic laser foraminoplasty on the lumbar spine - early experience.  Minim Invas Neurosurg. 1998;  41 5-9
• 7 Lew SM, Mehalic TF, Fagone KL. Transforaminal percutaneous endoscopic discectomy in the treatment of far-lateral and foraminal lumbar disc herniation.  J Neurosurgery [Spine 2]. 2001;  94 327-332
• 8 Mayer HM, Brock M. Percutaneous spinal endoscopy and discectomy (PELD).  Neurosurg Rev. 1993;  16 115-120
• 9 Kambin P, O'Brien E, Zhou L. et al . Arthroscopic microdiscectomy and selective fragmentectomy.  Clin Orthop. 1998;  347 150-167
• 10 Mathews HH. Transforaminal endoscopic microdiscectomy.  Neurosurg Clin North Am. 1996;  7 59-63
• 11 Suk KS, Lee HM, Moon SH. et al . Recurrent lumbar disc herniation: result of operative management.  Spine. 2001;  26 672-676
• 12 Carragee EJ, Han MY, Suen PW. et al . Clinical outcome after lumbar discectomy for sciatica: the effects of fragment type and annular competence.  J Bone Joint Surg [Am]. 2003;  85 102-108
• 13 Swartz KR, Trost GR. Recurrent lumbar disc herniation.  Neurosurg Focus. 2003;  15 1-4
• 14 Stambough JL. Recurrent same-level, ipsilateral lumbar disc herniation.  Orthop Rev. 1994;  23 810-816
• 15 MacNab I. Negative disc exploration: An analysis of the cause of nerve root involvement in sixty-eight patients.  J Bone Joint Surg [Am]. 1971;  53 891-903
• 16 Kambin P. Posterolateral percutaneous lumbar disectomy and decompression. In: Kambin P (ed.) Arthroscopic Microdiscectomy: Minimal Intervention in Spinal Surgery. Baltimore: Williams & Wilkins 1991: 67-100
• 17 Yeung AT. Spinal endoscopy with a multichannel, continuous irrigation discoscope with integrated inflow and outflow ports. Poster presentation. Fourth International Meeting on Advanced Spine Techniques.  , Bermuda 1997;  , July 10-13
• 18 Pfirrmann CW, Metzdorf A. Magnetic resonance classification of lumbar intervertebral disc degeneration.  Spine. 2001;  26 1873-1878
• 19 Cinotti G, Roysam GS, Eisenstein SM. et al . Ipsilateral recurrent lumbar disc herniation.  J Bone Joint Surg [Br]. 1998;  80 825-832
• 20 Connolly ES. Surgery for recurrent lumbar disc herniation.  Clin Neurosurg. 1992;  39 211-216
• 21 Ebeling U, Kalbarcyk H, Reulen HJ. Microsurgical reoperation following lumbar disc surgery. Timing, surgical findings, and outcome in 92 patients.  J Neurosurg. 1989;  70 397-404
• 22 Fandino J, Botana C, Viladrich A. et al . Reoperation after lumber disc surgery: results in 130 cases.  Acta Neurochir Wien. 1993;  122 102-104
• 23 Jackson RK. The long-term effects of wide laminectomy for lumbar disc excision: a review of 130 patients.  J Bone Joint Surg [Br]. 1971;  53 609-616
• 24 O'Sullivan MG, Connolly AE, Buckley TF. Recurrent lumbar disc protrusion.  Br J Neurosurg. 1990;  4 319-325
• 25 Ozgen S, Nadri S, Ozen MM. et al . Findings and outcome of revision lumbar disc surgery.  J Spinal Disord. 1999;  12 287-292
• 26 Herron L. Recurrent lumbar disc herniation: Results of repeat laminectomy and discectomy.  J Spinal Disord. 1994;  7 161-166
• 27 Andrews DW, Lavyne MH. Retrospective analysis of microsurgical and standard lumbar discetomy.  Spine. 1990;  15 329-335
• 28 Kambin P, Savitz MH. Arthroscopic microdiscectomy: an alternative to open surgery.  Mt Sinai J Med. 2000;  67 283-287
• 29 Chiu J, Clifford T, Batterjee K. et al .Extradural transpinal percutaneous L5-S1 endoscopic discectomy. In: Savitz M, Chiu J, Yeung A (eds.) The Practice of Minimally Invasive Spinal Technique. Richmond, VA: AAMISS EDUCATION, LLC 2000: 227-30
• 30 Modic MT, Steinberg PM, Ross JS. et al . Degenerative disk disease: assessment of change in vertebral body marrow with MR imaging.  Radiology. 1988;  166 193-199
• 31 Karchevsky M, Schweizer ME, Carrino JA. et al . Reactive endplate marrow changes: a systematic morphologic and epidemiologic evaluation.  Skeletal Radiol. 2005;  34 125-129

Correspondence