Browse > Article
http://dx.doi.org/10.3340/jkns.2009.46.6.515

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)
Publication Information
Journal of Korean Neurosurgical Society / v.46, no.6, 2009 , pp. 515-521 More about this Journal
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
Reherniation; Discectomy; Lumbar spine;
Citations & Related Records
Times Cited By KSCI : 1  (Citation Analysis)
Times Cited By Web Of Science : 2  (Related Records In Web of Science)
Times Cited By SCOPUS : 2
연도 인용수 순위
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   DOI   ScienceOn
2 Fairbank JC, Couper J, Davies JB, O'Brien JP : The Oswestry low back pain disability questionnaire. Physiotherapy 66 : 271-273, 1980   ScienceOn
3 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
4 Isaacs RE, Podichetty V, Fessler RG : Microendoscopic discectomy for recurrent disc herniation. Neurosurg Focus 15 : E11, 2003
5 Lee DY, Lee SH : Learning curve for percutaneous endoscopic lumbar discectomy. Neurol Med Chir (Tokyo) 48 : 383-388; discussion 388-389, 2008   DOI   ScienceOn
6 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   ScienceOn
7 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   DOI   ScienceOn
8 Swartz KR, Trost GR : Recurrent lumbar disc herniation. Neurosug Focus 15 : E10, 2003
9 Ozgen S, Naderi S, Ozek MM, Pamir MN : Findings and outcome of revision lumbar disc surgery. J Spinal Disord 12 : 287-292, 1999   ScienceOn
10 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
11 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   DOI   ScienceOn
12 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   DOI   ScienceOn
13 Vishteh AG, Dickman CA : Anterior lumbar microdiscectomy and interbody fusion for the treatment of recurrent disc herniation. Neurosurgery 48 : 334-337; discussion 338, 2001   DOI   ScienceOn
14 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   DOI   ScienceOn
15 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   DOI   ScienceOn
16 Javedan S, Sonntag VK : Lumbar disc herniation : microsurgical approach. Neurosurgery 52 : 160-162; discussion 162-164, 2003   DOI   ScienceOn
17 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   DOI   ScienceOn
18 Panjabi MM : Clinical spinal instability and low back pain. J Electromyogr Kinesiol 13 : 371-379, 2003   DOI   ScienceOn
19 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   DOI   ScienceOn
20 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   ScienceOn
21 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   DOI   ScienceOn
22 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   DOI   ScienceOn
23 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   DOI   ScienceOn
24 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   DOI
25 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   DOI   ScienceOn
26 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   ScienceOn
27 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   DOI   ScienceOn
28 Morgan-Hough CVJ, Jones PW, Eisenstein SM : Primary and revision lumbar discectomy. J Bone Joint Surg Br 85 : 871-874, 2003
29 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   DOI   ScienceOn
30 Le H, Sandhu FA, Fessler RG : Clinical outcomes after minimalaccess surgery for recurrent lumbar disc herniation. Neurosurg Focus 15 : E12, 2003
31 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   DOI
32 Kahanovitz N, Viola K, Gallagher M : Long-term strength assessment of postoperative diskectomy patients. Spine 14 : 402-403, 1989   DOI   ScienceOn
33 Suk KS, Lee HM, Moon SH, Kim NH : Recurrent lumbar disc herniation : results of operative management. Spine 26 : 672-676, 2001   DOI   ScienceOn
34 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   DOI
35 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
36 Silvers HR, Lewis PJ, Asch HL, Clabeaux DE : Lumbar diskectomy for recurrent disk herniation. J Spinal Disord 7 : 408-419, 1994   ScienceOn