Yuan Yao1, Huiyu Zhang2, Junlong Wu1, Huan Liu1, Zhengfeng Zhang1, Yu Tang3, Yue Zhou4. 1. Department of Orthopedics, Xinqiao Hospital, Third Military Medical University, Chongqing, China. 2. Department of Stomatology, the 457th Hospital of PLA, Wuhan, China. 3. Department of Orthopedics, Xinqiao Hospital, Third Military Medical University, Chongqing, China. Electronic address: tangyu628@sina.com. 4. Department of Orthopedics, Xinqiao Hospital, Third Military Medical University, Chongqing, China. Electronic address: happyzhou@vip.163.com.
Abstract
BACKGROUND: Patients who experience a recurrence of percutaneous endoscopic lumbar discectomy (PELD) need to undergo revision surgery when they fail to respond to conservative therapy. Minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF), microendoscopic discectomy (MED), and PELD are 3 common minimally invasive surgical approaches for PELD recurrence. However, there have been no studies that have focused on the selection of the minimally invasive surgical method for PELD recurrence. METHODS: Seventy-four patients who underwent revision surgery (MIS-TLIF, 26 cases; MED, 20 cases; PELD, 28 cases) for PELD recurrence were enrolled in this study. The preoperative characteristics and perioperative data were collected. Additionally, the clinical outcomes (visual analogue scale, Oswestry Disability Index, and the 12-item Short Form Health Survey) were collected and assessed at 1, 3, 6, 9, and 12 months postoperatively. RESULTS: No significant differences in clinical outcomes over time were observed between these 3 surgical approaches. MED and PELD were associated with greater pain-relief effects at 1 month after surgery than MIS-TLIF, but this effect equalized at 3 months postoperatively. MED and PELD exhibited the advantages of reductions in operation time, blood loss, hospital stay and total cost compared to MIS-TLIF. However, MED and PELD also were significantly associated with greater recurrence rates than MIS-TLIF. CONCLUSIONS: None of the three surgical approaches exhibited clear advantages in long-term pain or functional scores. MED and PELD were associated with lower costs and better perioperative effects than MIS-TLIF. However, compared with MIS-TLIF, the higher recurrence rates of MED and PELD should not be ignored.
BACKGROUND:Patients who experience a recurrence of percutaneous endoscopic lumbar discectomy (PELD) need to undergo revision surgery when they fail to respond to conservative therapy. Minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF), microendoscopic discectomy (MED), and PELD are 3 common minimally invasive surgical approaches for PELD recurrence. However, there have been no studies that have focused on the selection of the minimally invasive surgical method for PELD recurrence. METHODS: Seventy-four patients who underwent revision surgery (MIS-TLIF, 26 cases; MED, 20 cases; PELD, 28 cases) for PELD recurrence were enrolled in this study. The preoperative characteristics and perioperative data were collected. Additionally, the clinical outcomes (visual analogue scale, Oswestry Disability Index, and the 12-item Short Form Health Survey) were collected and assessed at 1, 3, 6, 9, and 12 months postoperatively. RESULTS: No significant differences in clinical outcomes over time were observed between these 3 surgical approaches. MED and PELD were associated with greater pain-relief effects at 1 month after surgery than MIS-TLIF, but this effect equalized at 3 months postoperatively. MED and PELD exhibited the advantages of reductions in operation time, blood loss, hospital stay and total cost compared to MIS-TLIF. However, MED and PELD also were significantly associated with greater recurrence rates than MIS-TLIF. CONCLUSIONS: None of the three surgical approaches exhibited clear advantages in long-term pain or functional scores. MED and PELD were associated with lower costs and better perioperative effects than MIS-TLIF. However, compared with MIS-TLIF, the higher recurrence rates of MED and PELD should not be ignored.