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KMID : 1040920180030020059
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Journal of Minimally Invasive Spine Surgery and Technique
2018 Volume.3 No. 2 p.59 ~ p.65
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Knuckling Down on Predictive Factors for Early Relapse after Posterolateral Percutaneous Endoscopic Lumbar Discectomy
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Mohapatra Bibhudendu
Adsul Nitin
Kim Hyeun-Sung
Paudel Byapak
Jang Jee-Soo
Choi Jeong-Hoon
Chung Sung-Kyun
Kim Jeong-Hoon
Jang Il-Tae
Oh Seong-Hoon
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Abstract
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Objective: Percutaneous endoscopic lumbar discectomy (PELD) has several advantages, but it is not used routinely due to early relapse and steep learning curve. We have studied the factors associated with early relapse in patients who underwent posterolateral PELD at or above the L4-5 level.
Methods: In this retrospective study, we have enrolled 200 cases and divided them into 4 groups (A, B, C, and D) with 50 patients in each group, that had undergone PELD by 2 different techniques (inside-out and outside-in with or without anti-adhesive agent) and operated by 2 different surgeons between May 2009 and November 2010. The factors studied were - Age, gender, disc (degeneration grade, location, level), associated adjacent level herniated nucleus pulposus (HNP), episode (first or recurrent), anti-adhesive agent, annulus preservation, approach, disc height and segmental dynamic motion (discrepancy in flexion and extension). Statistical analysis was done by Pearson’s chi-square test and p value (significance). The clinical results were evaluated by visual analogue scale (VAS).
Results: The mean age and mean followup period was comparable in all four groups. The overall recurrence rate was 9.5% (19/200). Average early relapse time was 3.26 months. Factors like Age of the patient, multilevel HNP and degeneration grade showed significant correlation with relapse rate. The change in VAS pre-operatively to post-operatively was significant across all groups (p<0.001).
Conclusion: Based on the results of this study, high grade disc degeneration, multilevel disc herniation, and early postoperative activity are significantly associated with early relapse after PELD.
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KEYWORD
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Endoscopic lumbar discectomy, Anti-adhesive agent, Recurrent disc herniation
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