Comparative Study between Endoscopic Lumbar Discectomy and Lumbar Fixation in Management of Recurrent Lumbar Disc Prolapse

Abstract

Abstract Background There is a great controversy in operative methods which can be used for recurrent lumbar disc herniation such as repeated endoscopic discectomy or repeated open discectomy either using fusion or not Endoscopic revision surgery can be conducted using the endoscopic interlaminar discectomy. Open surgery can be used for recurrent discectomy and lumbar fixation can be used in addition. Interbody fusion might be used as well. Patients and Methods The current study is a prospective, comparative study that included 90 patients with recurrent lumbar disc prolapse, who were scheduled for reoperation in Neurosurgical departments in Ain Shams University Hospitals and Other Affiliated Hospitals during time period from November 2016 to February 2022. Using spine endoscopy in 45 patients with recurrent disc prolapse (group 1) and fixation in another 45 patients (group 2). Results Operative time, wound length in centimeters, intraoperative bleeding, and the presence of a drain were compared between Group 1 and Group 2. All these variables showed statistically significant differences between the two groups showing better results in endoscopic group. Preoperatively, there was no statistically significant difference in JOA scores between Group 1 and Group 2. Immediately postoperative and at 1 week interval, endoscopic group had significantly higher JOA scores, indicating better outcomes. Preoperatively, there was no statistically significant difference in disability scores between Group 1 and Group 2. Immediately postoperative and at early time intervals, endoscopic group had significantly lower disability scores compared to fixation group. There were no statistically significant differences between Group 1 and Group 2 in terms of recurrence and stability rates. There was no statistically significant difference between Group 1 and Group 2 in terms of motor power outcome index. Conclusion Endoscopic lumbar discectomy is superior to open lumbar discectomy using fixation with or without fusion in the management of recurrent lumbar disc herniation, as for short-term results, however both techniques are equal in long-term results