400 - Successful Treatment of Recurrent Lumbar Disc Herniation Following Mic...

#400 Successful Treatment of Recurrent Lumbar Disc Herniation Following Microlaminotomy and Discectomy with Interspinous Device Implantation Using Percutaneous Endoscopic Discectomy

MIS Techniques and Outcomes

Poster Presented by: H.-K. Tsou

Author(s):

H.-K. Tsou (1)
T.-H. Kao (1)

(1) Taichung Veterans General Hospital, Department of Neurosurgery, Taichung, Taiwan, Republic of China

Abstract

Purpose: To present successful treatment experience of recurrent lumbar disc herniation following previous microlaminotomy and discectomy with interspinous device (IDs) implantation.

Summary of Background Data: IDs were introduced more than 10 years ago. The indications for these products were lumbar stenosis, lumbar herniated disc and mechanical lower back pain. Recurrent painful pathologies were reported following ID implantation with patients requiring reoperation for ID removal with fusion surgery sometimes. Here we present our experience of using percutaneous endoscopic lumbar discectomy (PELD) for treating patients with recurrent lumbar disc herniation following minimally decompressive discectomy with ID implantation.

Methods: From May 2009 ~ Aug. 2012, 102 cases with single to three level lumbar pathology were treated with minimally invasive decompression procedure (posterior microlaminotomy and discectomy) with the same ID implantation (Wallis, Zimmer spine). All patients were in regular outpatient clinic follow-up for at least one year. Postoperative dynamic flexion/extension and anterolateral X-ray were obtained during each visit. MRI lumbar spine study was performed immediately if recurrent clinical symptoms, new sciatica developed and recurrent spinal pathology was highly suspected. Once recurrent lumbar disc herniation at the same level (e.g. L3-4 or L4-5) was diagnosed and the patient agreed to PELD treatment, we performed this procedure under local anesthesia.

Results: 3 (3 %) cases of recurrent lumbar disc herniation were found according to the recurrent symptoms and MRI study. There were 1 male and 2 females. Mean age at the first operation was 52 (28-79). Mean recurrent period after first operation is 8.3 months (1.8- 12.07 months). PELD were performed by the same experienced spinal surgeon who had performed lumbar spine surgery on these patients before. The follow-up period after the last surgery (PELD) was 6 months. The average visual analog pain scale (VAS) for sciatica was 8.4 preoperatively and 1.2 postoperatively. The average VAS for back pain was 6.5 preoperatively and 2 postoperatively. No complications were found in these patients.

Conclusions: IDs were developed for dynamic stabilization of lumbar segments following minimally invasive decompression procedures. Recurrent lumbar disc herniation might occur even when IDs are used. PELD is a good treatment of choice for this recurrent disease in selected patients.