Objective: To investigate the causes of unplanned reoperation after percutaneous endoscopic discectomy for lumbar disc herniation.
Methods: 853 patients with lumbar disc herniation were treated by percutaneous endoscopic discectomy in Hwa Mei hospital from January 2018 to June 2021, of which 18 patients received unplanned reoperation. There were 7 males and 11 females, aged from 38 to 72, with an average of (56.8 ±11.3) years. There were 1 case of segment L3/4, 11 cases of segment L4/5, and 1 case of segment L3/4+L4/5. The follow-up time after reoperation ranged from 1 to 35 months, with an average of 8.5 months. VAS score, ODI index and MacNab criteria were adopted to evaluate the curative effect of the initial and revision operation. We made a descriptive analysis of the clinical data of patients with unplanned reoperation, so as to summarize the poor curative effect after percutaneous endoscopic surgery and the reasons for reoperation.
Results: A total of 18 patients with unplanned reoperation were collected, of which 2 patients received twice unplanned reoperation. All the 18 cases had ipsilateral herniation, including ipsilateral herniation in 17 cases and contralateral protrusion in 1 case. The methods of reoperation: 13 cases of PELD, 4 cases of decompression and internal fixation (PLIF×1, TLIF×3), 1 case of MED, 1 case of Endo-LIF, and 1 case of debridement. The causes of reoperation included incomplete decompression (residual nucleus pulposus, residual endplate, residual bone), recurrence, postoperative infection, nerve injury, hematoma, pseudocyst and so on. The follow-up time after reoperation ranged from 1 to 22 months, with an average of 8.61 ±3.52 months. The VAS score of low back pain decreased from 3.27 ±1.24 before operation to 1.21 ±0.32 at the last follow-up, the VAS score of leg pain decreased from 5.12 ±2.15 before operation to 1.98 ±1.20 at the last follow-up. The ODI index decreased from 32 ±16% to 10.4 ±6, and the difference was statistically significant (P < 0.05). At the last follow-up, the clinical efficacy was evaluated according to MacNab criteria (18 cases), including excellent in 14 cases, good in 3 cases, fair in 1 case and poor in 0 cases. The excellent and good rate was 94.4%.
Conclusion: There is the possibility of unplanned reoperation in the removal of nucleus pulposus under PELD. Besides, the appropriate operation method should be chosen according to the specific conditions of the lesion before operation. Incomplete decompression is the main cause of unplanned reoperation after PELD. Other causes include recurrence, infection, hematoma, nerve injury, pseudocyst.