Percutaneous endoscopic transforaminal discectomy for patients with recurrent lumbar disc herniation after fenestration discectomy

Objective To evaluate the feasibility of percutaneous endoscopic transforaminal lumbar discectomy (PELD) for the treatment of patients with recurrent lumbar disc herniation (RLDH) after fenestration discectomy. Methods Twenty-five patients with RLDH underwent PELD, including 18 males and 7 females, aged 26-61 years, from May 2013 to January 2019 were retrospectively summarized in the Department of Spine Surgery, Fuzhou Second Hospital Affliated to Xiamen University. The involved segments were L4-5 18 cases, and L5-S1 7 cases. All patients suffered from re-herniation were treated with fenestration discectomy for the first time. The mean pain-free interval was 20 months to 18 years. All patients showed lower extremity pain and numbness. The operation time was (85-120) min. PELD was used in a patient. The visual analogue scale (VAS) was applied to evaluate the effect at one day, three months and six months after the treatment. MacNab was used to assess the effect at six months after the treatment. The complications were also recorded. Results All patients successfully completed the operation, and no one was converted to traditional open surgery. The operation time was (93.7±8.6) min. Compared with pre-operation, VAS decreased significantly at one day, three months and six months after the operation in all patients (all P<0.05) . Six months after the operation, the effects were excellent in 18 cases, good in 5 cases, fair in 2 cases, and the excellent and good rate was 92% (23/25 cases) based on the MacNab evaluation. Conclusion The PELD is a good method for the treatment of patients with RLDH, by avoiding the scar tissue. Key words: Lumbar disc herniation; Postoperative fenestration of lamina; Discectomy; Recurrent; Percutaneous endoscopic transforaminal lumbar discectomy