Different surgical approaches for recurrent lumbar disc herniation after percutaneous endoscopic transforaminal discectomy: analysis of clinical and imaging outcomes.

OBJECTIVE

We compared the clinical efficacy of different surgical approaches for recurrent lumbar disc herniation (RLDH) after percutaneous endoscopic transforaminal discectomy (PETD).

METHODS

Eighty-seven patients with RLDH were included between June 2013 and June 2022, of whom 38 underwent percutaneous endoscopic interlaminar discectomy (PEID) and 49 underwent PETD again. We compared perioperative variables as well as clinical and imaging outcomes. Clinical evaluations consisted of visual analog scale for back pain (VAS-B) and leg pain (VAS-L), Japanese Orthopedic Association score (JOA), and Oswestry disability index (ODI). Imaging measurements consisted of disc height index (DHI), range of motion (ROM), and sagittal translation (ST).

RESULTS

Compared to the PETD group, the PEID group presented shorter operative time and fewer fluoroscopy times (P < 0.05); nevertheless, intraoperative blood loss, hospital stay, incision length, and the complication rate showed no significant between-group difference (P > 0.05). Both groups showed significant clinical improvement postoperatively (P < 0.05). At 7 days after surgery, VAS-B, VAS-L, JOA, and ODI showed greater improvement in the PEID group compared with the PETD group (P < 0.05). There were no significant between-group differences in imaging data (P > 0.05). Postoperative ROM and ST remained below instability thresholds, and no lumbar instability was observed.

CONCLUSION

For patients with RLDH after PETD, both PEID and PETD achieve satisfactory clinical efficacy. PEID provides advantages over PETD by reducing operative time and fluoroscopy, and is effective in avoiding scar tissue formation from initial surgery. These findings suggest that PEID may be preferable in selected recurrent cases, particularly where scar tissue or anatomical barriers compromise transforaminal access.