Abstract

Background Recurrent herniation is a significant problem as scar formation and progressive disc degeneration may lead to increased morbidity after traditional posterior re-operation. The advantage of the ETD could be that there is no need to go through the old scar tissue. The disadvantage may be a long learning curve for the spinal surgeon. Purpose To review complications and results of the endoscopic transforaminal discectomy (ETD) for recurrent herniated discs. Study Design A prospective clinical study. Patient Sample 262 consecutive patients over a four year period with a MRI proven disc-herniation in the lumbar spine with radicular symptoms, positive Lasegue, numbness or adynamia in the leg that did not respond satisfactory to conservative treatment over 3 months. Previous surgery had been performed in our own centre in 82 cases, 180 patients had previous surgery performed elsewhere. Outcome Measures The patients had a clinical evaluation 3 months after surgery and returned at two years an extensive questionnaire including VAS Scores, MacNab Score as well as subjective satisfaction Methods First a discography of at least 2 levels was conducted. The prolapsed or ruptured part of the posterior disc segment was removed with special forceps and special curettes. The procedure was performed under local anaesthesia. Results At two years 85,7% of the patients rated the result of the surgery as excellent or good. 9,7 % reported a fair and 4,6 % patients an unsatisfactory result. Patients recorded an average improvement of their back pain of 5,7 points and 5,9 points of their leg pain on the VAS scale(1-10). According to Mac Nab criteria 30,7% of the patients felt fully regenerated, 50 % felt their efficiency to be slightly restricted, 16,8% felt their efficiency noticeably restricted and 2,5% felt unaltered. All patients had a 3-month follow-up where possible complications were registered. The complication included: 3 nerve root irritations and 6 (2,3%) early recurrent herniations (<3 month). There was no case of infection or discitis. 11 patients have been reoperated for recurrence, after 3 months and within 2 years ( 4,6%). Conclusion Endoscopic transforaminal discectomy appears to be an effective treatment with few complications and a high patient satisfaction for recurrent disc herniation.