Wang Yan, Liu Houchen, Lin Antao, Zhang Hao, Ma Xuexiao
Department of Orthopedics, The Affiliated Hospital of Qingdao University, Qingdao, China.
Orthop Surg. 2023 Oct;15(10):2602-2611. doi: 10.1111/os.13844. Epub 2023 Aug 3.
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.
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.
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 L 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.
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 L RLDH after previous FETD and for L5S1 RLDH.
全内镜下腰椎间盘切除术（FELD）后无法预防复发性腰椎间盘突出症（RLDH），FELD术后RLDH的最佳手术治疗方案仍存在争议。本研究的目的是提出一种FELD手术策略，用于治疗既往FELD术后的RLDH，并展示手术效果。
回顾性分析2015年2月至2022年3月期间接受FELD手术治疗的68例RLDH患者。针对早期复发（24小时至2周）提出了一种原手术入路方法。对于需要局部麻醉的患者，以及有FETD指征或FEID技术困难的RLDH患者，考虑采用全内镜经椎间孔技术（FETD）。对于有FEID指征的RLDH患者，选择全内镜椎板间技术（FEID）。如果不存在FEID或FETD技术困难，FEID和FETD均适用。采用视觉模拟量表（VAS）评分、Oswestry功能障碍指数（ODI）和改良MacNab标准评估临床疗效。记录术后24小时、3个月和末次随访的随访数据。采用t检验评估手术时间和临床疗效。p值<0.05被认为具有统计学意义。
68例患者平均随访时间为23.8个月（范围6至76个月）。在13例早期复发患者中，原手术入路组的手术时间（32.30±9.67 vs. 58.00±6.16分钟）短于改手术入路组（p<0.05）。在28例L节段FETD复发（>2周）患者中，FETD组的手术时间（66.17±12.18 vs. 53.60±5.45分钟）长于FEID组（p<0.05）。在22例L5S1节段复发（>2周）患者中，FEID组的手术时间（55.75±8.79 vs. 79.33±6.65分钟）短于FETD组（p<0.05）。与术前相比，术后24小时、3个月和末次随访时的VAS和ODI评分均显著改善（p<0.05）。根据改良MacNab标准，88.23%的患者显示出优或良的结果。3个月时3例患者再次复发。68例患者均未观察到手术并发症。
FELD是治疗既往FELD术后RLDH的一种安全有效的治疗选择。对于早期复发，建议采用原手术入路。FEID和FETD对复发（>2周）均有效且安全，但FEID对于既往FETD术后的L节段RLDH和L5S1节段RLDH似乎更有效。
