Revision for Endoscopic Diskectomy: Is Lateral Lumbar Interbody Fusion an Option?

OBJECTIVE: This study aims to report the clinical outcome of stand-alone lateral lumbar interbody fusion (LLIF) on recurrent disk herniation and to compare the outcome of stand-alone LLIF to that of conventional transforaminal lumbar interbody fusion (TLIF). METHODS: A retrospective study of 47 patients with recurrent disk herniation was included from January 2008 to October 2016. The inclusion criteria were 1) with recurrent disk herniation that needs revision surgery, 2) with only 1 previous percutaneous endoscopic lumbar diskectomy surgery, 3) underwent 1-level stand-alone LLIF or 1-level TLIF surgery, and 4) with follow-up more than 1 year. Patients were asked to complete the following questionnaires for outcome evaluation: visual analog scales (VAS) for both low back pain and leg pain, the Oswestry Disability Index (ODI), and the 12-item Short-Form Health Survey. RESULTS: Eighteen patients underwent stand-alone LLIF, and 29 patients underwent TLIF surgery. Radiographic analysis revealed a similar baseline and postoperative lumbar lordosis in both the LLIF and TLIF groups. Two weeks after surgery, the ODI and VAS scores showed a significant decrease in both groups. The TLIF group showed significantly larger postoperative VAS back pain after surgery (P = 0.03). For both VAS leg pain and ODI score during follow-up, no significance difference was found between the LLIF and TLIF groups. CONCLUSIONS: Stand-alone LLIF is a safe and effective approach with low morbidity and acceptable complication rates for patients with recurrent disk herniation after a previous percutaneous endoscopic lumbar diskectomy surgery. Compared with the TLIF procedure, LLIF could achieve a similar improvement of patient-reported outcome with a better VAS back pain score.