Surgical Strategy and Outcomes of Full Endoscopic Lumbar Discectomy for Recurrent Lumbar Disk Herniation Following a Previous Full Endoscopic Lumbar Discectomy
Objective Recurrent lumbar disc herniation (RLDH) cannot be prevented after full endoscopic lumbar discectomy (FELD), and the optimal surgical treatment for RLDH after FELD remains controversial. The aim of the study was to suggest a surgical strategy for FELD to treat RLDH following a previous FELD...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2023-10-01
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| Series: | Orthopaedic Surgery |
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| Online Access: | https://doi.org/10.1111/os.13844 |
| _version_ | 1797666336051036160 |
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| author | Yan Wang Houchen Liu Antao Lin Hao Zhang Xuexiao Ma |
| author_facet | Yan Wang Houchen Liu Antao Lin Hao Zhang Xuexiao Ma |
| author_sort | Yan Wang |
| collection | DOAJ |
| description | Objective Recurrent lumbar disc herniation (RLDH) cannot be prevented after full endoscopic lumbar discectomy (FELD), and the optimal surgical treatment for RLDH after FELD remains controversial. The aim of the study was to suggest a surgical strategy for FELD to treat RLDH following a previous FELD and to present surgical outcomes. Methods Between February 2015 and March 2022, 68 patients with RLDH were surgically treated with FELD retrospectively. An original approach was suggested for the treatment of early recurrence (24 h‐2 weeks). The full endoscopic transforaminal technique (FETD) was considered for patients requiring local anesthesia, and in RLDH with FETD indications or FEID technological difficulties. The full endoscopic interlaminar technique (FEID) was chosen in RLDH with FEID indications. Both FEID and FETD were suitable if no FEID or FETD technological difficulties existed. Clinical efficacy was evaluated using the visual analog scale (VAS) score, Oswestry disability index (ODI), and modified MacNab criteria. Postoperative follow‐up data at 24 h, 3 months, and final‐follow‐up were recorded. Operation time and clinical outcomes were assessed with t test. p‐value < 0.05 was considered statistically significant. Results All 68 patients had an average follow‐up time of 23.8 months (range, 6–76 months). In the 13 cases of early recurrence, the operation time (32.30 ± 9.67 vs. 58.00 ± 6.16 min) in the original surgical approach group was shorter than that in the changing surgical approach group (p < 0.05). In the 28 cases of L4/5 FETD recurrence (>2 weeks), the operation time (66.17 ± 12.18 vs. 53.60 ± 5.45 min) in the FETD group was more than that in the FEID group (p < 0.05). In the 22 cases of L5S1 recurrence (>2 weeks), the operation time (55.75 ± 8.79 vs. 79.33 ± 6.65 min) in the FEID group was shorter than in the FETD group (p < 0.05). The postoperative VAS and ODI scores at 24 h, 3 months, and final‐follow up were all significantly improved, compared with their preoperative counterparts (p < 0.05). Based on the modified MacNab criteria, 88.23% of patients showed excellent or good results. Re‐recurrence occurred in three patients at 3 months. No surgical complications were observed in any of the 68 cases. Conclusion FELD is a safe and effective treatment option for RLDH with previous FELD. For early recurrence, the original approach was suggested. Both FEID and FETD were effective and safe for recurrence (>2 weeks), but FEID seemed more efficient for L4/5 RLDH after previous FETD and for L5S1 RLDH. |
| first_indexed | 2024-03-11T19:58:08Z |
| format | Article |
| id | doaj.art-0d8c64c62e124757b85ce8dd8ea32556 |
| institution | Directory Open Access Journal |
| issn | 1757-7853 1757-7861 |
| language | English |
| last_indexed | 2024-03-11T19:58:08Z |
| publishDate | 2023-10-01 |
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| series | Orthopaedic Surgery |
| spelling | doaj.art-0d8c64c62e124757b85ce8dd8ea325562023-10-04T14:23:12ZengWileyOrthopaedic Surgery1757-78531757-78612023-10-0115102602261110.1111/os.13844Surgical Strategy and Outcomes of Full Endoscopic Lumbar Discectomy for Recurrent Lumbar Disk Herniation Following a Previous Full Endoscopic Lumbar DiscectomyYan Wang0Houchen Liu1Antao Lin2Hao Zhang3Xuexiao Ma4Department of Orthopedics The Affiliated Hospital of Qingdao University Qingdao ChinaDepartment of Orthopedics The Affiliated Hospital of Qingdao University Qingdao ChinaDepartment of Orthopedics The Affiliated Hospital of Qingdao University Qingdao ChinaDepartment of Orthopedics The Affiliated Hospital of Qingdao University Qingdao ChinaDepartment of Orthopedics The Affiliated Hospital of Qingdao University Qingdao ChinaObjective Recurrent lumbar disc herniation (RLDH) cannot be prevented after full endoscopic lumbar discectomy (FELD), and the optimal surgical treatment for RLDH after FELD remains controversial. The aim of the study was to suggest a surgical strategy for FELD to treat RLDH following a previous FELD and to present surgical outcomes. Methods Between February 2015 and March 2022, 68 patients with RLDH were surgically treated with FELD retrospectively. An original approach was suggested for the treatment of early recurrence (24 h‐2 weeks). The full endoscopic transforaminal technique (FETD) was considered for patients requiring local anesthesia, and in RLDH with FETD indications or FEID technological difficulties. The full endoscopic interlaminar technique (FEID) was chosen in RLDH with FEID indications. Both FEID and FETD were suitable if no FEID or FETD technological difficulties existed. Clinical efficacy was evaluated using the visual analog scale (VAS) score, Oswestry disability index (ODI), and modified MacNab criteria. Postoperative follow‐up data at 24 h, 3 months, and final‐follow‐up were recorded. Operation time and clinical outcomes were assessed with t test. p‐value < 0.05 was considered statistically significant. Results All 68 patients had an average follow‐up time of 23.8 months (range, 6–76 months). In the 13 cases of early recurrence, the operation time (32.30 ± 9.67 vs. 58.00 ± 6.16 min) in the original surgical approach group was shorter than that in the changing surgical approach group (p < 0.05). In the 28 cases of L4/5 FETD recurrence (>2 weeks), the operation time (66.17 ± 12.18 vs. 53.60 ± 5.45 min) in the FETD group was more than that in the FEID group (p < 0.05). In the 22 cases of L5S1 recurrence (>2 weeks), the operation time (55.75 ± 8.79 vs. 79.33 ± 6.65 min) in the FEID group was shorter than in the FETD group (p < 0.05). The postoperative VAS and ODI scores at 24 h, 3 months, and final‐follow up were all significantly improved, compared with their preoperative counterparts (p < 0.05). Based on the modified MacNab criteria, 88.23% of patients showed excellent or good results. Re‐recurrence occurred in three patients at 3 months. No surgical complications were observed in any of the 68 cases. Conclusion FELD is a safe and effective treatment option for RLDH with previous FELD. For early recurrence, the original approach was suggested. Both FEID and FETD were effective and safe for recurrence (>2 weeks), but FEID seemed more efficient for L4/5 RLDH after previous FETD and for L5S1 RLDH.https://doi.org/10.1111/os.13844Full Endoscopic Lumbar DiscectomyLumbar Disc HerniationSurgical Technique |
| spellingShingle | Yan Wang Houchen Liu Antao Lin Hao Zhang Xuexiao Ma Surgical Strategy and Outcomes of Full Endoscopic Lumbar Discectomy for Recurrent Lumbar Disk Herniation Following a Previous Full Endoscopic Lumbar Discectomy Orthopaedic Surgery Full Endoscopic Lumbar Discectomy Lumbar Disc Herniation Surgical Technique |
| title | Surgical Strategy and Outcomes of Full Endoscopic Lumbar Discectomy for Recurrent Lumbar Disk Herniation Following a Previous Full Endoscopic Lumbar Discectomy |
| title_full | Surgical Strategy and Outcomes of Full Endoscopic Lumbar Discectomy for Recurrent Lumbar Disk Herniation Following a Previous Full Endoscopic Lumbar Discectomy |
| title_fullStr | Surgical Strategy and Outcomes of Full Endoscopic Lumbar Discectomy for Recurrent Lumbar Disk Herniation Following a Previous Full Endoscopic Lumbar Discectomy |
| title_full_unstemmed | Surgical Strategy and Outcomes of Full Endoscopic Lumbar Discectomy for Recurrent Lumbar Disk Herniation Following a Previous Full Endoscopic Lumbar Discectomy |
| title_short | Surgical Strategy and Outcomes of Full Endoscopic Lumbar Discectomy for Recurrent Lumbar Disk Herniation Following a Previous Full Endoscopic Lumbar Discectomy |
| title_sort | surgical strategy and outcomes of full endoscopic lumbar discectomy for recurrent lumbar disk herniation following a previous full endoscopic lumbar discectomy |
| topic | Full Endoscopic Lumbar Discectomy Lumbar Disc Herniation Surgical Technique |
| url | https://doi.org/10.1111/os.13844 |
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