Percutaneous Endoscopic Lumbar Diskectomy and Minimally Invasive Transforaminal Lumbar Interbody Fusion for Recurrent Lumbar Disk Herniation

OBJECTIVE: To compare the clinical outcomes of patients with recurrent lumbar disk disease undergoing percutaneous endoscopic lumbar diskectomy or minimally invasive transforaminal lumbar interbody fusion at a single clinic. METHODS: From January 2008 to January 2014, 401 consecutive patients with first recurrence of lumbar disk herniation were treated with percutaneous endoscopic lumbar diskectomy (PELD) or minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF). These data collected prospectively for analysis were clinical and radiographic results after revision surgery and complications. RESULTS: During the follow-up period, postoperative data between both groups showed no significant differences in the mean total postoperative visual analog scale score for leg pain, Japanese Orthopaedic Association score, and Oswestry Disability Index score. The recovery rate was 92.3% in the PELD and 97.4% in the MIS-TLIF group. Regarding satisfactory rate, the PELD group (91.3%) was lower than the MIS-TLIF group (95.2%). Six cases of dural tear were observed in the MIS-TLIF group. The second recurrence occurred in 12 patients in the PELD group. In the PELD group, 1 patient suffered from permanent neurologic deficit. One case of postoperative intervertebral infection was captured in the MIS-TLIF group. CONCLUSIONS: Both PELD and MIS-TLIF showed favorable clinical outcomes for recurrent disk herniation. Compared with MIS-TLIF, PELD has the following several advantages: 1) performed under local anesthesia; 2) performed with very few approach-related complications, such as dural tear; and 3) rare possibility of fusion disease, such as adjacent segment. However, PELD is also faced with several problems, such as 1) the relative higher rate of postoperative long-term chronic low back pain, and (2) the possibility of recurrence, despite the opportunity being low.