Is Transforaminal Endoscopic Discectomy the Best Option for Recurrent Lumbar Disc Herniation? A Systematic Review.

IF 1.7 Q2 SURGERY International Journal of Spine Surgery Pub Date : 2025-03-06 DOI:10.14444/8698

Gerald Musa, Medetbek D Abakirov, Naya Arzoumi, Samat T Mamyrbaev, Rossi E Barrientos Castillo, Gennady E Chmutin, Jeff Ntalaja, Tshiunza Mpoyi Chérubin, Edinson David Berrio Perea, Gervit Reyes-Soto, Carlos Castillo-Rangel, Manuel De Jesus Encarnacion Ramirez, Nicola Montemurro

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Abstract

Introduction: Recurrent lumbar disc herniation (rLDH) remains a challenge in spinal surgery. This systematic review analyzes the use of transforaminal endoscopic discectomy (TFED) for the treatment of rLDH.

Methods: A comprehensive search of 4 electronic databases, including PubMed, Google Scholar, Science Direct, and Cochrane, was conducted. Studies that analyzed the use of TFED to manage rLDH were included in the review. The primary outcomes assessed in these studies encompassed postoperative complications, length of surgery, blood loss, duration of hospitalization, pain scores, and recurrence rates.

Results: Six studies met the inclusion criteria, comprising 405 patients. The mean duration of surgery was 24 to 158.74 minutes with intraoperative estimated blood loss of 0 to 34.8 mL. The mean recurrence rate was 4.4% with a 0.7% progression to fusion during the follow-up period. Durotomy was seen in 2.7% of cases. There was a 0.1% incidence of temporary nerve irritation with no permanent nerve injuries reported.

Conclusions: TFED for the management of rLDH is a lateral minimally invasive technique that avoids going through scar tissue, hence associated with a short duration of surgery, minimal to no measurable blood loss, and a very low complication rate. The few studies in the literature seem to suggest that TFED should be considered in patients with rLDH without segmental instability who meet the criteria for surgery.

Level of evidence: 5:

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椎间孔内窥镜椎间盘切除术是治疗复发性腰椎间盘突出症的最佳选择吗？系统评价。

复发性腰椎间盘突出（rLDH）仍然是脊柱外科的一个挑战。本系统综述分析了经椎间孔内窥镜椎间盘切除术（TFED）治疗rLDH的应用。方法：综合检索PubMed、谷歌Scholar、Science Direct、Cochrane 4个电子数据库。分析使用TFED治疗rLDH的研究也被纳入本综述。这些研究评估的主要结果包括术后并发症、手术时间、出血量、住院时间、疼痛评分和复发率。结果：6项研究符合纳入标准，共纳入405例患者。平均手术时间为24 ~ 158.74分钟，术中估计失血量为0 ~ 34.8 mL。随访期间平均复发率为4.4%，融合率为0.7%。2.7%的病例行硬膜切开术。暂时性神经刺激发生率为0.1%，无永久性神经损伤报道。结论：TFED治疗rLDH是一种外侧微创技术，可避免穿过瘢痕组织，因此手术时间短，出血量最小或无出血量，并发症发生率极低。文献中的少数研究似乎表明，对于没有节段性不稳定且符合手术标准的rLDH患者，应考虑TFED。证据等级：5；

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来源期刊

International Journal of Spine Surgery Medicine-Surgery

CiteScore

3.10

自引率

0.00%

发文量

162

期刊介绍： The International Journal of Spine Surgery is the official scientific journal of ISASS, the International Intradiscal Therapy Society, the Pittsburgh Spine Summit, and the Büttner-Janz Spinefoundation, and is an official partner of the Southern Neurosurgical Society. The goal of the International Journal of Spine Surgery is to promote and disseminate online the most up-to-date scientific and clinical research into innovations in motion preservation and new spinal surgery technology, including basic science, biologics, and tissue engineering. The Journal is dedicated to educating spine surgeons worldwide by reporting on the scientific basis, indications, surgical techniques, complications, outcomes, and follow-up data for promising spinal procedures.