Chi Heon Kim1, Chun Kee Chung, Seil Sohn, Sungjoon Lee, Sung Bae Park. 1. *Department of Neurosurgery, Seoul National University Hospital †Department of Neurosurgery, Seoul National University College of Medicine ‡Neuroscience Research Institute, Seoul National University Medical Research Center §Clinical Research Institute, Seoul National University Hospital ∥Department of Brain and Cognitive Sciences, Seoul National University College of Natural Sciences, Seoul ¶Department of Neurosurgery, Inje University Haeundae Paik Hospital, Pusan #Department of Neurosurgery, Seoul National University Boramae Hospital, Seoul, Republic of Korea.
Abstract
STUDY DESIGN: A retrospective analysis. OBJECTIVE: To present the surgical outcome of percutaneous endoscopic discectomy (PED) for recurrent herniated intervertebral disk disease (HIVD) and to suggest a surgical strategy. SUMMARY OF BACKGROUND DATA: Revision discectomy is technically demanding because of the scar tissue, unclear anatomic planes, and retraumatization to the posterior structures. Although open microdiscectomy is a standard method, endoscopic techniques have emerged as a surgical alternative with comparable results. PED was performed with either the transforaminal (PETD) or the interlaminar approach (PEID). Previous reports have shown the surgical outcomes of PETD or PEID for recurrent HIVD, but the application of each approach was not addressed clearly. METHODS: Consecutive 26 patients (M:F=16:10, mean age 53.1±12.4 y), who underwent PED for recurrent HIVD, were enrolled. The previous operation was an open discectomy in 22, a PETD in 2, and a PEID in 2 patients. PETD was considered preferentially, if it was feasible (n=11), because of the scar tissue formed by the previous operation. PEID was chosen (n=15) because of a high iliac crest (8), high canal compromise (3), high-grade inferior migration (2), and narrow neural foramen (2). All patients were followed up for 19.3±11.3 months. RESULTS: In all patients, the recurrent disk material was removed successfully, and conversion to an open surgery was not necessary. Postoperative magnetic resonance imaging revealed that the ruptured disk was removed successfully in all cases. A favorable outcome (excellent or good outcome by MacNab's criteria) was achieved in 21 patients (81%). Re-recurrence occurred in 2 patients at 6 and 12 months postoperatively. Risk factors for an unfavorable outcome were not found in the present study (P>0.05). CONCLUSIONS: The relevant utilization of updated surgical techniques may be helpful in overcoming the difficulty of revision surgery.
STUDY DESIGN: A retrospective analysis. OBJECTIVE: To present the surgical outcome of percutaneous endoscopic discectomy (PED) for recurrent herniated intervertebral disk disease (HIVD) and to suggest a surgical strategy. SUMMARY OF BACKGROUND DATA: Revision discectomy is technically demanding because of the scar tissue, unclear anatomic planes, and retraumatization to the posterior structures. Although open microdiscectomy is a standard method, endoscopic techniques have emerged as a surgical alternative with comparable results. PED was performed with either the transforaminal (PETD) or the interlaminar approach (PEID). Previous reports have shown the surgical outcomes of PETD or PEID for recurrent HIVD, but the application of each approach was not addressed clearly. METHODS: Consecutive 26 patients (M:F=16:10, mean age 53.1±12.4 y), who underwent PED for recurrent HIVD, were enrolled. The previous operation was an open discectomy in 22, a PETD in 2, and a PEID in 2 patients. PETD was considered preferentially, if it was feasible (n=11), because of the scar tissue formed by the previous operation. PEID was chosen (n=15) because of a high iliac crest (8), high canal compromise (3), high-grade inferior migration (2), and narrow neural foramen (2). All patients were followed up for 19.3±11.3 months. RESULTS: In all patients, the recurrent disk material was removed successfully, and conversion to an open surgery was not necessary. Postoperative magnetic resonance imaging revealed that the ruptured disk was removed successfully in all cases. A favorable outcome (excellent or good outcome by MacNab's criteria) was achieved in 21 patients (81%). Re-recurrence occurred in 2 patients at 6 and 12 months postoperatively. Risk factors for an unfavorable outcome were not found in the present study (P>0.05). CONCLUSIONS: The relevant utilization of updated surgical techniques may be helpful in overcoming the difficulty of revision surgery.
Authors: Young Hoon Choi; Shin Won Kwon; Jung Hyeon Moon; Chi Heon Kim; Chun Kee Chung; Sung Bae Park; Won Heo Journal: J Korean Neurosurg Soc Date: 2017-10-25