Journal of Korean Neurosurgical Society

The Korean Neurosurgical Society (대한신경외과학회)
권호 표지
DOI QR코드

DOI QR Code

Comparison of Percutaneous Endoscopic Lumbar Discectomy and Open Lumbar Microdiscectomy for Recurrent Disc Herniation

  • Lee, Dong-Yeob (Department of Neurosurgery, Wooridul Spine Hospital) ;
  • Shim, Chan-Shik (Department of Neurosurgery, Wooridul Spine Hospital) ;
  • Ahn, Yong (Department of Neurosurgery, Wooridul Spine Hospital) ;
  • Choi, Young-Geun (Department of Neurosurgery, Wooridul Spine Hospital) ;
  • Kim, Ho-Jin (Department of Neurosurgery, Wooridul Spine Hospital) ;
  • Lee, Sang-Ho (Department of Neurosurgery, Wooridul Spine Hospital)
  • Published : 2009.12.28
Download PDF
⟨ Previous Next ⟩

Abstract

Objective : The purpose of this study was to compare clinical and radiological outcomes of percutaneous endoscopic lumbar discectomy (PELD) and open lumbar microdiscectomy (OLM) for recurrent disc herniation. Methods : Fifty-four patients, who underwent surgery, either PELD (25 patients) or repeated OLM (29 patients), due to recurrent disc herniation at L4-5 level, were divided into two groups according to the surgical methods. Excluded were patients with sequestrated disc, calcified disc, severe neurological deficit, or instability. Clinical outcomes were assessed using Visual Analogue Scale (VAS) score and Oswestry Disability Index (ODI). Radiological variables were assessed using plain radiography and/or magnetic resonance imaging. Results : Mean operating time and hospital stay were significantly shorter in PELD group (45.8 minutes and 0.9 day, respectively) than OLM group (73.8 minutes and 3.8 days, respectively) (p < 0.001). Complications occurred in 4% in PELD group and 10.3% in OLM group in the perioperative period. At a mean follow-up duration of 34.2 months, the mean improvements of back pain, leg pain, and functional improvement were 4.0, 5.5, and 40.9% for PELD group and 2.3, 5.1, and 45.0% for OLM group, respectively. Second recurrence occurred in 4% after PELD and 10.3% after OLM. Disc height did not change after PELD, but significantly decreased after OLM (p = 0.0001). Neither sagittal rotation angle nor volume of multifidus muscle changed significantly in both groups. Conclusion : Both PELD and repeated OLM showed favorable outcomes for recurrent disc herniation, but PELD had advantages in terms of shorter operating time, hospital stay, and disc height preservation.

Keywords

References

  1. Ahn Y, Lee SH, Park WM, Lee HY, Shin SW, Kang HY : Percutaneous endoscopic lumbar discectomy for recurrent disc herniation : surgical technique, outcome, and prognostic factors of 43 consecutive cases. Spine 29 : E326- E332, 2004 https://doi.org/10.1097/01.BRS.0000134591.32462.98
  2. Carragee EJ, Spinnickie AO, Alamin TF, Paragioudakis S : A prospective controlled study of limited versus subtotal posterior discectomy : short-term outcomes in patients with herniated lumbar intervertebral discs and large posterior annular defect. Spine 31 : 653-657, 2006 https://doi.org/10.1097/01.brs.0000203714.76250.68
  3. Carreon LY, Puno RM, Dimar JR 2nd, Glassman SD, Johnson JR : Perioperative complications of posterior lumbar decompression and arthrodesis in older adults. J Bone Joint Surg Am 85 : 2089-2092, 2003 https://doi.org/10.2106/00004623-200311000-00004
  4. Choi G, Raiturker PP, Kim MJ, Chung DJ, Chae YS, Lee SH : The effect of early isolated lumbar extension exercise program for patients with herniated disc undergoing lumbar discectomy. Neurosurgery 57 : 764-772; discussion 764-772, 2005 https://doi.org/10.1093/neurosurgery/57.4.764
  5. Choi KB, Lee DY, Lee SH : Contralateral reherniation after open lumbar microdiscectomy; a comparison with ipsilateral reherniation. J Korean Neurosurg Soc 44 : 320-326, 2008 https://doi.org/10.3340/jkns.2008.44.5.320
  6. Cinotti G, Gumina S, Giannicola G, Postacchini F : Contralateral recurrent lumbar disc herniation : results of discectomy compared with those in primary herniation. Spine 24 : 800-806, 1999 https://doi.org/10.1097/00007632-199904150-00012
  7. Cinotti G, Roysam GS, Eisenstein SM, Postacchini F : Ipsilateral recurrent lumbar disc herniation. A prospective, controlled study. J Bone Joint Surg Br 80 : 825-832, 1998 https://doi.org/10.1302/0301-620X.80B5.8540
  8. Dai LY, Zhou Q, Yao WF, Shen L : Recurrent lumbar disc herniation after discectomy : outcome of repeated discectomy. Surg Neurol 64 : 226-231; discussion 231, 2005 https://doi.org/10.1016/j.surneu.2004.11.003
  9. Fairbank JC, Couper J, Davies JB, O'Brien JP : The Oswestry low back pain disability questionnaire. Physiotherapy 66 : 271-273, 1980
  10. Fu TS, Lai PL, Tsai TT, Niu CC, Chen LH, Chen WJ : Long-term results of disc excision for recurrent lumbar disc herniation with or without posterolateral fusion. Spine 30 : 2830-2834, 2005 https://doi.org/10.1097/01.brs.0000190393.15369.94
  11. Herkowitz HN, Garfin SR, Balderston RA, Eismont FJ, Bell GR, Wiesel SW : Rothman-Simeone The Spine, ed 4. Philadelphia : W.B. Saunders Company, 1999, pp1089-1093
  12. Hoogland T, Schubert M, Miklitz B, Ramirez A : Transforaminal posterolateral endoscopic discectomy with or without the combination of a low-dose chymopapain : a prospective randomized study in 280 consecutive cases. Spine 24 : E890-E897, 2006
  13. Hoogland T, van den Brekel-Dijkstra K, Schubert M, Miklitz B : Endoscopic transforaminal discectomy for recurrent lumbar disc herniation : a prospective, cohort evaluation of 262 consecutive cases. Spine 33 : 973-978, 2008 https://doi.org/10.1097/BRS.0b013e31816c8ade
  14. Isaacs RE, Podichetty V, Fessler RG : Microendoscopic discectomy for recurrent disc herniation. Neurosurg Focus 15 : E11, 2003
  15. Javedan S, Sonntag VK : Lumbar disc herniation : microsurgical approach. Neurosurgery 52 : 160-162; discussion 162-164, 2003 https://doi.org/10.1097/00006123-200301000-00021
  16. Kahanovitz N, Viola K, Gallagher M : Long-term strength assessment of postoperative diskectomy patients. Spine 14 : 402-403, 1989 https://doi.org/10.1097/00007632-198904000-00010
  17. Le H, Sandhu FA, Fessler RG : Clinical outcomes after minimalaccess surgery for recurrent lumbar disc herniation. Neurosurg Focus 15 : E12, 2003
  18. Lee DY, Ahn Y, Lee SH : Percutaneous endoscopic lumbar discectomy for adolescent lumbar disc herniation : surgical outcomes in 46 consecutive patients. Mt Sinai J Med 73 : 864-870, 2006
  19. Lee DY, Lee SH : Learning curve for percutaneous endoscopic lumbar discectomy. Neurol Med Chir (Tokyo) 48 : 383-388; discussion 388-389, 2008 https://doi.org/10.2176/nmc.48.383
  20. Lee S, Kim SK, Lee SH, Kim WJ, Choi WC, Choi G, et al. : Percutaneous endoscopic lumbar discectomy for migrated disc herniation : classification of disc migration and surgical approaches. Eur Spine J 16 : 431-437, 2007 https://doi.org/10.1007/s00586-006-0219-4
  21. Lee SH, Chung SE, Ahn Y, Kim TH, Park JY, Shin SW : Comparative radiologic evaluation of percutaneous endoscopic lumbar discectomy and open microdiscectomy : a matched cohort analysis. Mt Sinai J Med 73 : 795-801, 2006
  22. Lee SH, Kang BU, Ahn Y, Choi G, Choi YG, Ahn KU, et al. : Operative failure of percutaneous endoscopic lumbar discectomy : a radiological analysis of 55 cases. Spine 31 : E285-E290, 2006 https://doi.org/10.1097/01.brs.0000216446.13205.7a
  23. Manchikanti L, Pampati V, Baha AG, Fellows B, Damron KS, Barnhill RC : Contribution of facet joints to chronic low back pain in postlumbar laminectomy syndrome : a controlled comparative prevalence evaluation. Pain Physician 4 : 175-180, 2001
  24. Mochida J, Nishimura K, Nomura T : Appropriate procedure of posterior herniotomy and percutaneous nucleotomy in lumbar disc herniation. Rinsho Seikei Geka 29 : 423-430, 1994
  25. Morgan-Hough CVJ, Jones PW, Eisenstein SM : Primary and revision lumbar discectomy. J Bone Joint Surg Br 85 : 871-874, 2003
  26. Osman SG, Nibu K, Panjabi MM, Marsolais EB, Chaudhary R : Transforaminal and posterior decompression of the lumbar spine. A comparative study of stability and intervertebral foraminal area. Spine 22 : 1690-1695, 1997 https://doi.org/10.1097/00007632-199708010-00002
  27. Ozgen S, Naderi S, Ozek MM, Pamir MN : Findings and outcome of revision lumbar disc surgery. J Spinal Disord 12 : 287-292, 1999
  28. Panjabi MM : Clinical spinal instability and low back pain. J Electromyogr Kinesiol 13 : 371-379, 2003 https://doi.org/10.1016/S1050-6411(03)00044-0
  29. Saxler G, Kramer J, Barden B, Kurt A, Pfortner J, Bernsmann K : The long-term clinical sequelae of incidental durotomy in lumbar disc surgery. Spine 30 : 2298-2302, 2005 https://doi.org/10.1097/01.brs.0000182131.44670.f7
  30. Shin DA, Kim KN, Shin HC, Yoon do H : The efficacy of microendoscopic discectomy in reducing iatrogenic muscle injury. J Neurosurg Spine 8 : 39-43, 2008 https://doi.org/10.3171/SPI-08/01/039
  31. Sihvonen T, Herno A, Paljarvi L, Airaksinen O, Partanen J, Tapaninaho A : Local denervation atrophy of paraspinal muscles in postoperative failed back syndrome. Spine 18 : 575-581, 1993 https://doi.org/10.1097/00007632-199304000-00009
  32. Silvers HR, Lewis PJ, Asch HL, Clabeaux DE : Lumbar diskectomy for recurrent disk herniation. J Spinal Disord 7 : 408-419, 1994
  33. Suk KS, Lee HM, Moon SH, Kim NH : Recurrent lumbar disc herniation : results of operative management. Spine 26 : 672-676, 2001 https://doi.org/10.1097/00007632-200103150-00024
  34. Swartz KR, Trost GR : Recurrent lumbar disc herniation. Neurosug Focus 15 : E10, 2003
  35. Vishteh AG, Dickman CA : Anterior lumbar microdiscectomy and interbody fusion for the treatment of recurrent disc herniation. Neurosurgery 48 : 334-337; discussion 338, 2001 https://doi.org/10.1097/00006123-200102000-00018
  36. Yeung AT, Tsou PM : Posterolateral endoscopic excision for lumbar disc herniation : surgical technique, outcome, and complications in 307 consecutive cases. Spine 27 : 722-731, 2002 https://doi.org/10.1097/00007632-200204010-00009

Cited by

  1. Changes in Back Pain After Percutaneous Endoscopic Lumbar Discectomy and Annuloplasty for Lumbar Disc Herniation: A Prospective Study vol.12, pp.11, 2011, https://doi.org/10.1111/j.1526-4637.2011.01250.x
  2. Minimally Invasive Surgical Treatment Options for Lumbar Disc Herniations and Stenosis vol.23, pp.1, 2009, https://doi.org/10.1053/j.semss.2010.11.004
  3. Clinical Results of Interlaminar Approach for Endoscopic Discectomy in the Herniated Lumbar Disc at L5-S1 vol.8, pp.1, 2009, https://doi.org/10.14245/kjs.2011.8.1.31
  4. Comparative Study of the Outcomes of Percutaneous Endoscopic Lumbar Discectomy and Microscopic Lumbar Discectomy Using the Tubular Retractor System Based on the VAS, ODI, and SF-36 vol.9, pp.3, 2009, https://doi.org/10.14245/kjs.2012.9.3.215
  5. Accuracy of Marker Placement by Magnetic Resonance Imaging in the Determination of the Incision Site in Lumbar Disk Surgeries vol.23, pp.2, 2009, https://doi.org/10.1097/wnq.0b013e31825a693f
  6. The “inside out” transforaminal technique to treat lumbar spinal pain in an awake and aware patient under local anesthesia: results and a review of the literature vol.8, pp.None, 2009, https://doi.org/10.14444/1028
  7. Comparison of Percutaneous Endoscopic Lumbar Discectomy and Open Lumbar Surgery for Adjacent Segment Degeneration and Recurrent Disc Herniation vol.2015, pp.None, 2009, https://doi.org/10.1155/2015/791943
  8. Lumbar Endoscopic Microdiscectomy: Where Are We Now? An Updated Literature Review Focused on Clinical Outcome, Complications, and Rate of Recurrence vol.2015, pp.None, 2009, https://doi.org/10.1155/2015/417801
  9. Unsuccessful Percutaneous Endoscopic Lumbar Discectomy vol.76, pp.4, 2009, https://doi.org/10.1227/neu.0000000000000628
  10. Lumbar microdiscectomy complication rates: a systematic review and meta-analysis vol.39, pp.4, 2009, https://doi.org/10.3171/2015.7.focus15281
  11. Surgical Outcome of Two-Level Transforaminal Percutaneous Endoscopic Lumbar Discectomy for Far-Migrated Disc Herniation vol.2016, pp.None, 2009, https://doi.org/10.1155/2016/4924013
  12. Learning curves of percutaneous endoscopic lumbar discectomy in transforaminal approach at the L4/5 and L5/S1 levels: a comparative study vol.17, pp.None, 2016, https://doi.org/10.1631/jzus.b1600002
  13. Revision percutaneous endoscopic lumbar discectomy under the local anesthesia for the recurrent lumbar herniated nucleus pulposus in a high class athlete: A case Report vol.63, pp.1, 2009, https://doi.org/10.2152/jmi.63.135
  14. Foraminoplastic Superior Vertebral Notch Approach with Reamers in Percutaneous Endoscopic Lumbar Discectomy : Technical Note and Clinical Outcome in Limited Indications of Percutaneous Endoscopic Lumb vol.59, pp.2, 2016, https://doi.org/10.3340/jkns.2016.59.2.172
  15. Minimally invasive tubular microdiscectomy for recurrent lumbar disc herniation vol.24, pp.1, 2016, https://doi.org/10.3171/2015.4.spine14883
  16. The Effect and Feasibility Study of Transforaminal Percutaneous Endoscopic Lumbar Discectomy Via Superior Border of Inferior Pedicle Approach for Down-Migrated Intracanal Disc Herniations vol.95, pp.8, 2009, https://doi.org/10.1097/md.0000000000002899
  17. Treatment of Recurrent Disc Herniation: A Systematic Review vol.8, pp.5, 2009, https://doi.org/10.7759/cureus.622
  18. Application of transiliac approach to intervertebral endoscopic discectomy in L5/S1 intervertebral disc herniation vol.22, pp.1, 2009, https://doi.org/10.1186/s40001-017-0254-0
  19. Percutaneous endoscopic lumbar discectomy: Results of first 100 cases vol.51, pp.1, 2017, https://doi.org/10.4103/0019-5413.197520
  20. Clinical Outcome of Percutaneous Endoscopic Lumbar Surgery (PELS) in Treatment of Lumbar Disc Herniation vol.7, pp.4, 2009, https://doi.org/10.4236/ojo.2017.74012
  21. Comprehensive comparing percutaneous endoscopic lumbar discectomy with posterior lumbar internal fixation for treatment of adjacent segment lumbar disc prolapse with stable retrolisthesis : A retrosp vol.96, pp.29, 2009, https://doi.org/10.1097/md.0000000000007471
  22. The debate on most ideal technique for managing recurrent lumbar disc herniation: a short review vol.31, pp.6, 2017, https://doi.org/10.1080/02688697.2017.1368451
  23. Percutaneous endoscopic lumbar discectomy: minimally invasive technique for multiple episodes of lumbar disc herniation vol.18, pp.None, 2009, https://doi.org/10.1186/s12891-017-1697-8
  24. Surgical Treatment of Recurrent Lumbar Disk Herniation: A Systematic Review and Meta-analysis vol.41, pp.4, 2018, https://doi.org/10.3928/01477447-20180621-01
  25. Foraminoplasty at the Tip or Base of the Superior Articular Process for Lateral Recess Stenosis in Percutaneous Endoscopic Lumbar Discectomy: A Multicenter, Retrospective, Controlled Study with 2-Year vol.2018, pp.None, 2009, https://doi.org/10.1155/2018/7692794
  26. A Comparison of Percutaneous Endoscopic Lumbar Discectomy and Open Lumbar Microdiscectomy for Lumbar Disc Herniation in the Korean: A Meta-Analysis vol.2018, pp.None, 2009, https://doi.org/10.1155/2018/9073460
  27. Meta-analysis of percutaneous transforaminal endoscopic discectomy vs. fenestration discectomy in the treatment of lumbar disc herniation vol.47, pp.7, 2018, https://doi.org/10.1007/s00132-018-3528-5
  28. Percutaneous endoscopic lumbar discectomy by transfacet joint approach : A case report vol.97, pp.48, 2009, https://doi.org/10.1097/md.0000000000013373
  29. Clinical comparison of unilateral biportal endoscopic technique versus open microdiscectomy for single-level lumbar discectomy: a multicenter, retrospective analysis vol.13, pp.None, 2009, https://doi.org/10.1186/s13018-018-0725-1
  30. Acute Cauda Equina Syndrome after Percutaneous Transforaminal Endoscopic Discectomy vol.3, pp.2, 2009, https://doi.org/10.21182/jmisst.2018.00367
  31. Percutaneous Endoscopic Lumbar Discectomy versus Conventional Open Discectomy: A Prospective Randomized Comparative Trial vol.9, pp.2, 2009, https://doi.org/10.4236/ojmn.2019.92010
  32. Evolution of Spinal Endoscopic Surgery vol.16, pp.1, 2009, https://doi.org/10.14245/ns.1836322.161
  33. The Successful Evolution of Endoscopic Spine Surgery: Coincidence or Human Spirit? vol.16, pp.1, 2009, https://doi.org/10.14245/ns.19edi.001
  34. Outcomes of endoscopic discectomy compared with open microdiscectomy and tubular microdiscectomy for lumbar disc herniations: a meta-analysis vol.31, pp.6, 2009, https://doi.org/10.3171/2019.6.spine19532
  35. Comparison of Percutaneous Endoscopic Lumbar Discectomy with Minimally Invasive Transforaminal Lumbar Interbody Fusion as a Revision Surgery for Recurrent Lumbar Disc Herniation after Percutaneous End vol.16, pp.None, 2009, https://doi.org/10.2147/tcrm.s283652
  36. Removal of calcified lumbar disc herniation with endoscopic-matched ultrasonic osteotome - Our preliminary experience vol.34, pp.1, 2009, https://doi.org/10.1080/02688697.2019.1687850
  37. Percutaneous Endoscopic Transforaminal Discectomy versus Conventional Open Lumbar Discectomy for Upper Lumbar Disc Herniation: A Comparative Cohort Study vol.2020, pp.None, 2009, https://doi.org/10.1155/2020/1852070
  38. Comparison of postoperative outcomes between patients with positive and negative straight leg raising tests who underwent full-endoscopic transforaminal lumbar discectomy vol.10, pp.1, 2009, https://doi.org/10.1038/s41598-020-73357-w
  39. Clinical efficacy of single intraoperative 500 mg methylprednisolone management therapy for thoracic myelopathy caused by ossification of the ligamentum flavum vol.21, pp.None, 2009, https://doi.org/10.1186/s12891-020-03216-2
  40. Is fusion the most suitable treatment option for recurrent lumbar disc herniation? A systematic review vol.42, pp.12, 2009, https://doi.org/10.1080/01616412.2020.1787661
  41. Percutaneous endoscopic lumbar discectomy compared with other surgeries for lumbar disc herniation : A meta-analysis vol.100, pp.9, 2009, https://doi.org/10.1097/md.0000000000024747
  42. Endoscopic Spine Surgery in Athletes: Case Series and Review of Literature vol.145, pp.None, 2009, https://doi.org/10.1016/j.wneu.2020.08.211
  43. Learning curve of percutaneous endoscopic transforaminal lumbar discectomy by a single surgeon vol.100, pp.4, 2009, https://doi.org/10.1097/md.0000000000024346
  44. Is Endoscopic Discectomy the Next Gold Standard in the Management of Lumbar Disc Disease? Systematic Review and Superiority Analysis vol.11, pp.7, 2021, https://doi.org/10.1177/2192568220948814
  45. The association between pain scores and disc height change following discectomy surgery in lumbar disc herniation patients: a systematic review and meta-analysis vol.30, pp.11, 2009, https://doi.org/10.1007/s00586-021-06891-4