Recurrent lumbar disc herniation after conventional discectomy: a prospective, randomized study comparing full-endoscopic interlaminar and transforaminal versus microsurgical revision.

STUDY

DESIGN

Prospective, randomized, controlled study of patients with recurrent lumbar disc herniations after conventional discectomy, operated either in a full-endoscopic or microsurgical technique.

OBJECTIVE

Comparison of results of lumbar revision discectomies in full-endoscopic interlaminar and transforaminal technique with the conventional microsurgical technique.

SUMMARY OF BACKGROUND DATA: Recurrences after lumbar disc operations cannot be prevented. Because of the existing scarring, the risk of intraoperative complications may be increased and consecutive damage may arise owing to greater traumatization. In disc surgery, tissue-sparing interventions are becoming more widespread. Endoscopic techniques have become the standard in many areas because of the advantages they offer intraoperatively and postoperatively. With the transforaminal and interlaminar techniques, 2 full-endoscopic procedures are available for the lumbar spine.

METHODS

Eighty-seven patients with recurrent herniation after conventional discectomy underwent full-endoscopic or microsurgical intervention and were followed for 2 years. In addition to general and specific parameters, the following measuring instruments were used: visual analog scale, German version of the North American Spine Society Instrument, Oswestry Low-Back Pain Disability Questionnaire.

RESULTS

Postoperatively, 79% of the patients no longer had leg pain, and 16% had occasional pain. The clinical results were the same in both groups. The re-recurrence rate was 5.7% with no difference between the groups. The full-endoscopic techniques brought significant advantages in the following areas: rehabilitation, complications, and traumatization.

CONCLUSIONS

The clinical results of the full-endoscopic technique are equal to those of the microsurgical technique. At the same time, there are advantages in the operation technique and reduced traumatization. With the surgical devices and the possibility of selecting an interlaminar or posterolateral to lateral transforaminal procedure, recurrent lumbar disc herniations can be sufficiently removed using the full-endoscopic technique. Full-endoscopic surgery is a sufficient and safe supplementation and alternative to microsurgical procedures.