Transforaminal Endoscopic Lumbar Discectomy for Lumbosacral Junction Adolescent Lumbar Disc Herniation with High Iliac Crests

Comparison of the efficacy of microendoscopic discectomy and percutaneous endoscopic lumbar discectomy for treating adolescent lumbar disc herniation

Microendoscopic discectomy (MED) has long been employed as the standard operation for adolescent lumbar disc herniation (ALDH). However, due to iatrogenic injury, it has been suspected to cause adverse effects. Alternatively, percutaneous endoscopic lumbar discectomy (PELD) is considered as effective as MED. Few studies have compared MED and PELD in the treatment of ALDH. The purpose of this study was to compare the possible differences in young patients who underwent MED or PELD. From January 2011 to January 2021, 49 consecutive patients were treated with MED (17 patients) or PELD (32 patients) at the authors institution. Numeric Rating Scales (NRS) scores, Oswestry Disability Index (ODI) and modified MacNab criteria demonstrated significant improvement in both early and late follow-up evaluations (P < 0.01). PELD group resulted in shorter operative times and lower re-operation and complication rate. The PELD group exhibited shorter incision length, length of hospital stay and less intraoperative blood loss than the MED group. Both PELD and MED have demonstrated great efficacy in managing symptomatic ALDH. PELD appears to offer superior control over surgical trauma and promotes rapid recovery compared to MED.

Repeat Surgery after Percutaneous Endoscopic Lumbar Discectomy for Adolescent Lumbar Disc Herniation: A Multicenter Observational Study

OBJECTIVE

The reported date in the repeat surgical intervention for adolescent lumbar disc herniation (ALDH) after percutaneous endoscopic lumbar discectomy (PELD) was quite scarce. This study aims to introduce cases of repeat surgeries after PELD for ALDH and assess the incidence, chief causes, repeat surgery methods, and surgical outcomes of repeat surgeries after PELD for ALDH.

METHODS

A retrospective multicenter observational study was conducted on patients undergoing repeat surgeries after PELD for ALDH at four tertiary referral hospitals from January 2014 through August 2022. The incidence of repeat surgeries, chief causes, strategies for repeat surgeries, and timing of repeat surgeries were recorded and analyzed. The clinical outcomes were evaluated by the Numeric Rating Scales (NRS) scores and the modified MacNab criteria. Statistical analyses were performed with the Wilcoxon signed-rank test.

RESULTS

A total of 23 patients who underwent repeat surgeries after PELD for ALDH were included. The chief causes were re-herniation (homo-lateral re-herniation at the same level, new disc herniation of adjacent level). The repeat surgery methods were revision PELD, micro-endoscopic discectomy (MED), open discectomy and instrumented lumbar inter-body fusion. The NRS scores decreased significantly in follow-up evaluations and these scores demonstrated significant improvement at the last follow-up (p < 0.002). For the modified MacNab criteria, at the last follow-up, 18 patients (78.26%) had an excellent outcome, and the overall success rate was 86.95%.

CONCLUSION

This study's data suggest that young patients who underwent repeat surgery improved significantly compared to baseline. The chief cause was re-herniation. Revision PELD was the main surgical procedure, which provides satisfactory clinical results in young patients who underwent repeat surgeries.

[Short- and mid-term outcomes after posterolateral endoscopic discectomy in patients with lumbosacral junction disc herniations]

OBJECTIVE

To analyze the short- and mid-term results of posterolateral endoscopic discectomy (PLED) in patients with lumbosacral junction intervertebral discs (IVD) herniations.

MATERIAL AND METHODS

A retrospective observational cohort study included 95 medical records of respondents (35 (36.8%) males, 60 (63.2%) females, age 21 - 72 years), who underwent PLED for lumbar IVD herniations. Mean postoperative follow-up period was 14.4±3.2 months. Clinical outcomes and incidence of complications were studied.

RESULTS

VAS scores of back and lower limb pain significantly decreased after 1, 3, 6, 9 and 12 months (p<0.01). Disability significantly improved in short- and mid-term follow-up period (Oswestry Disability Index, p<0.01). Analysis of subjective satisfaction with surgical intervention (modified MacNab scale) revealed that 92 (92.9%) respondents had excellent results. Complications occurred in 5 (5.2%) patients.

CONCLUSION

PLED is effective and safe in patients with lumbosacral joint IVD herniations. No significant complications were noted in our respondents.