Recurrence of Lumbar Disc Herniation after Microendoscopic Discectomy

Abstract

Background Although microendoscopic discectomy (MED) is a minimally invasive surgical method for lumbar disc herniation (LDH), early postoperative recurrence may outweigh that advantage. The purpose of the present study was to retrospectively investigate the recurrence rate after MED for LDH and to determine the risk factors for recurrence in patients treated by a single surgeon.

Materials and Methods The study included 344 patients who underwent MED (213 males and 131 females; mean age, 39.3 years; age range, 11–82 years; mean follow-up, 3.6 years; follow-up range, 2.0–6.5 years). The clinical outcomes were evaluated using the Japanese Orthopedic Association Score for Low Back Pain (JOA score). Recurrence factors investigated by logistic regression analysis included age; sex; level, laterality, and classified type of LDH; occupation; sports activity; and learning curve of the surgeon.

Results LDH recurrence was observed in 37 patients (10.8%). It was observed at the same level in the ipsilateral side as the original LDH in 30 patients, in the contralateral side in three patients, and at a level adjacent to the original level in four patients. The mean time interval between MED and the recurrence was 16.6 months (range, 0.5–52 months). Twenty patients (54.1%) developed recurrence within 1 year after MED. Twenty-two patients (59.5%) were treated by revision surgery (MED in 20 patients and microdiscectomy in two patients), and 15 patients (40.5%) were treated conservatively. The mean JOA score of all the patients was 14.7 ± 3.5 before surgery and 26.5 ± 2.2 at the final follow-up, yielding an average recovery rate of 82.3 ± 15.7%. The recovery rate was 83.1 ± 14.8% in patients without recurrence and 75.7 ± 20.4% in patients with recurrence (p = 0.006). By logistic regression analysis, we identified migration of LDH as a significant factor related to recurrence. The patients with caudal migration of LDH had recurrence more frequently (19.0%) than those with rostral migration (12.5%) or without migration (10.2%) (p = 0.04; odds ratio, 2.0; 95% confidence interval, 1.0–3.8).

Conclusion The recurrence rate and reoperation rate for LDH after MED were comparable to those of conventional discectomy. More than half of the cases of recurrence occurred at an early postoperative phase, and patients with caudally migrated LDH experienced recurrence significantly more often than those with rostrally migrated or nonmigrated LDH.

Keywords

lumbar disc herniation - microendoscopic discectomy - recurrence - risk factor

• References

• 1 Foley KT, Smith MM. Microendoscopic Discectomy. Techniques in Neurosurgery vol 3, No 4, pp 301–307. Lippincott-Raven Publishers; Philadelphia: 1997
• 2 Huang TJ, Hsu RW, Li YY, Cheng CC. Less systemic cytokine response in patients following microendoscopic versus open lumbar discectomy. J Orthop Res 2005; 23 (2) 406-411
• 3 Righesso O, Falavigna A, Avanzi O. Comparison of open discectomy with microendoscopic discectomy in lumbar disc herniations: results of a randomized controlled trial. Neurosurgery 2007; 61 (3) 545-549 , discussion 549
• 4 Shin DA, Kim KN, Shin HC, Yoon H. The efficacy of microendoscopic discectomy in reducing iatrogenic muscle injury. J Neurosurg Spine 2008; 8 (1) 39-43
• 5 Arts MP, Peul WC, Brand R, Koes BW, Thomeer RT. Cost-effectiveness of microendoscopic discectomy versus conventional open discectomy in the treatment of lumbar disc herniation: a prospective randomised controlled trial [ISRCTN51857546]. BMC Musculoskelet Disord 2006; 7: 42
• 6 Wu X, Zhuang S, Mao Z, Chen H. Microendoscopic discectomy for lumbar disc herniation: surgical technique and outcome in 873 consecutive cases. Spine 2006; 31 (23) 2689-2694
• 7 Khoo LT, Fessler RG. Microendoscopic decompressive laminotomy for the treatment of lumbar stenosis. Neurosurgery 2002; 51 (5, Suppl) S146-S154
• 8 Matsumoto M, Chiba K, Ishii K, Watanabe K, Nakamura M, Toyama Y. Microendoscopic partial resection of the sacral ala to relieve extraforaminal entrapment of the L-5 spinal nerve at the lumbosacral tunnel. Technical note. J Neurosurg Spine 2006; 4 (4) 342-346
• 9 Matsumoto M, Watanabe K, Tuji T , et al. Microendoscopic discectomy for lumbar disc herniation with bony fragment due to apophyseal separation. Minim Invasive Neurosurg 2007; 50 (6) 335-339
• 10 Ishii K, Matsumoto M, Watanabe K, Nakamura M, Chiba K, Toyama Y. Endoscopic resection of cystic lesions in the lumbar spinal canal: a report of two cases. Minim Invasive Neurosurg 2005; 48 (4) 240-243
• 11 Matsumoto M, Watanabe K, Tsuji T , et al. Microendoscopic resection of lumbar discal cysts. Minim Invasive Neurosurg 2010; 53 (2) 69-73
• 12 Teli M, Lovi A, Brayda-Bruno M , et al. Higher risk of dural tears and recurrent herniation with lumbar micro-endoscopic discectomy. Eur Spine J 2010; 19 (3) 443-450
• 13 Matsumoto M, Hasegawa T, Ito M , et al. Incidence of complications associated with spinal endoscopic surgery: nationwide survey in 2007 by the Committee on Spinal Endoscopic Surgical Skill Qualification of Japanese Orthopaedic Association. J Orthop Sci 2010; 15 (1) 92-96
• 14 Matsumoto M, Ishii K, Watanabe K , et al. Microendoscopic discectomy for lumbar disc herniation in the elderly. Asian Journal of Endoscopic Surgery 2010; 3: 174-179
• 15 Izumida S, Inoue S. Assessment of treatment for low back pain. J Jpn Orthop Assoc 1986; 60: 391-394
• 16 Yorimitsu E, Chiba K, Toyama Y, Hirabayashi K. Long-term outcomes of standard discectomy for lumbar disc herniation: a follow-up study of more than 10 years. Spine 2001; 26 (6) 652-657
• 17 Häkkinen A, Kiviranta I, Neva MH, Kautiainen H, Ylinen J. Reoperations after first lumbar disc herniation surgery; a special interest on residives during a 5-year follow-up. BMC Musculoskelet Disord 2007; 8: 2
• 18 Kim MS, Park KW, Hwang C , et al. Recurrence rate of lumbar disc herniation after open discectomy in active young men. Spine 2009; 34 (1) 24-29
• 19 Kim KT, Park SW, Kim YB. Disc height and segmental motion as risk factors for recurrent lumbar disc herniation. Spine 2009; 34 (24) 2674-2678
• 20 McGirt MJ, Ambrossi GL, Datoo G , et al. Recurrent disc herniation and long-term back pain after primary lumbar discectomy: review of outcomes reported for limited versus aggressive disc removal. Neurosurgery 2009; 64 (2) 338-344 , discussion 344–345
• 21 Moliterno JA, Knopman J, Parikh K , et al. Results and risk factors for recurrence following single-level tubular lumbar microdiscectomy. J Neurosurg Spine 2010; 12 (6) 680-686
• 22 Casal-Moro R, Castro-Menéndez M, Hernández-Blanco M , et al. Long-term outcome after microendoscopic diskectomy for lumbar disk herniation: a prospective clinical study with a 5-year follow-up. Neurosurgery 2011; 68 (6) 1568-1575 , discussion 1575