A study on the percutaneous endoscopic strategy of recurrence revision in middle-aged and elderly patients after PEID

doi:10.3877/cma.j.issn.2096-0263.2025.02.004

Abstract

Abstract:

Objectives

To explore the endoscopic revision and surgical techniques for middle-aged or elderly people with L₅/S₁ recurrent lumbar disc herniation（rLDH）after percutaneous endoscopic interlaminar discectomy （PEID）.

Methods

From May 2018 to October 2022， 52 middle-aged or elderly patients who underwent percutaneous endoscopic lumbar discectomy for L₅/S₁ rLDH after PEID were enrolled in the present study，including 28 males and 24 females with a mean age of 58.154±10.634 years.Based on strategy of the endoscopic revision， patients were divided into PETD group （n=22） and PEID group （n=30），and their demographic data and surgery-related indicators were compared. The visual analogue scale （VAS） for back and leg pain， oswestry disability index （ODI） and Japanese Orthopaedic Association Score （JOA） were recorded to evaluate the clinical outcomes.

Results

No significant differences were found in the demographic data， operative time， and intraoperative blood loss between the two groups （P＞0.05）， but the time of intraoperative X-ray fluoroscopy exposures in the PEID group were significantly shorter than that in the PETD group（P＜0.05）.The follow-up data of the two groups were analyzed by repeated-measures ANOVA，which showed no statistically significant differences between the groups（P＞0.05），statistically significant differences between the different time points （P＜0.05）， and no interaction between the groups and the time points （P＞0.05）. No serious complication observed during the follow-up.

Conclusions

For recurrent LDH after PEID of L₅/S₁ segments， percutaneous endoscopic revision can achieve satisfactory results. And since the time of intraoperative X-ray fluoroscopy exposures in the PEID group are shorter， the PEID technique is considered as the preferred revision technique when both procedures can remove the compressive material well.And for several specific types of recurrence，mastering the application of the two procedures can effectively minimize the difficulty of the surgery.

Key words: Lumbar Vertebrae, Diskectomy，Percutaneous, Endoscopes, Reoperation

Antao Lin, Yan Wang, Hao Zhang, Kai Zhu, Dan Zhou, Jianwei Guo, Wenhao Zhao, Chuanli Zhou, Xuexiao Ma. A study on the percutaneous endoscopic strategy of recurrence revision in middle-aged and elderly patients after PEID[J]. Chinese Journal of Geriatric Orthopaedics and Rehabilitation(Electronic Edition), 2025, 11(02): 102-110.

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Figures/Tables 9

组别	例数	性别（例，男/女）	年龄（岁， $\overset{ˉ}{x}$ ±s）	BMI（kg/m²， $\overset{ˉ}{x}$ ±s）	术中失血量（ml， $\overset{ˉ}{x}$ ±s）	手术时间（分， $\overset{ˉ}{x}$ ±s）	透视时间（秒， $\overset{ˉ}{x}$ ±s）
PETD	22	12/10	55.73±10.63	25.268±3.579	11.073±4.257	71.955±9.454	11.909±3.176
PEID	30	16/14	59.93±10.45	26.287±3.334	12.410±4.915	68.333±8.679	8.733±2.258
χ ²/ t 值		0.008	-1.423	-1.055	-1.025	1.412	4.218
P 值		0.931	0.161	0.296	0.310	0.165	＜0.001

组别	例数	性别（例，男/女）	年龄（岁， $\overset{ˉ}{x}$ ±s）	BMI（kg/m²， $\overset{ˉ}{x}$ ±s）	术中失血量（ml， $\overset{ˉ}{x}$ ±s）	手术时间（分， $\overset{ˉ}{x}$ ±s）	透视时间（秒， $\overset{ˉ}{x}$ ±s）
PETD	22	12/10	55.73±10.63	25.268±3.579	11.073±4.257	71.955±9.454	11.909±3.176
PEID	30	16/14	59.93±10.45	26.287±3.334	12.410±4.915	68.333±8.679	8.733±2.258
χ ²/ t 值		0.008	-1.423	-1.055	-1.025	1.412	4.218
P 值		0.931	0.161	0.296	0.310	0.165	＜0.001

组别	例数	术前	术后1 周	术后1 月	术后6 月	术后12 月	F 值	P 值
PETD组	22	7.227±1.232	3.409±1.008^a	2.271±0.528^ab	0.909±0.610^abc	0.364±0.492^abcd	451.620	＜0.001
PEID组	30	6.800±1.031	3.500±0.731^a	2.233±0.568^ab	0.900±0.803^abc	0.367±0.615^abcd
F 值		0.371
P 值		0.545

组别	例数	术前	术后1 周	术后1 月	术后6 月	术后12 月	F 值	P 值
PETD组	22	7.476±0.680	3.000±0.837^a	1.571±0.507^ab	0.905±0.625^abc	0.095±0.301^abcd	923.570	＜0.001
PEID组	30	7.333±0.844	3.067±0.828^a	1.633±0.669^ab	0.700±0.794^abc	0.133±0.346^abcd
F 值		0.186
P 值		0.668

组别	例数	术前	术后1 周	术后1 月	术后6 月	术后12 月	F 值	P 值
PETD组	22	62.222±5.655	17.475±1.721^a	11.717±1.561^ab	9.293±1.766^abc	7.273±1.705^abcd	1045.696	＜0.001
PEID组	30	60.593±6.941	16.727±1.387^a	10.889±1.686^ab	9.260±2.266^abc	7.112±1.971^abcd
F 值		2.225
P 值		0.142

组别	例数	术前	术后1 周	术后1 月	术后6 月	术后12 月	F 值	P 值
PETD组	22	9.909±1.823	18.773±1.270^a	22.364±0.790^ab	24.955±1.174^abc	25.864±1.167^abcd	640.255	＜0.001
PEID组	30	10.333±2.057	19.567±1.501^a	22.300±0.837^ab	24.300±1.088^abc	25.533±1.306^abcd
F 值		0.045
P 值		0.834

References 22

1	丛志超，许德荣，周传利，等.两种可视化关节突成形技术治疗腰椎间盘突出症的早期临床疗效比较［J］.中华骨与关节外科杂志，2021，14（7）：592-599，610.
2	Kanno H，Aizawa T， Hahimoto K， et al. Minimally invasive discectomy for lumbar disc herniation： current concepts， surgical techniques，and outcomes［J］.Int Orthop，2019，43（4）：917-922.
3	Choi KC， Kim JS， Park CK. Percutaneous endoscopic lumbar discectomy as an alternative to open lumbar microdiscectomy for large lumbar disc herniation［J］.Pain Physician，2016，19（2）：E291-E300.
4	Ruetten S， Komp M， Merk H， et al. Recurrent lumbar disc herniation after conventional discectomy： a prospective， randomized study comparing full-endoscopic interlaminar and transforaminal versus microsurgical revision ［J］. J Spinal Disord Tech， 2009， 22（2）：122-129.
5	Wang Y， Liu HC， Lin AT， et al. Surgical strategy and outcomes of full endoscopic lumbar discectomy for recurrent lumbar disk herniation following a previous full endoscopic lumbar discectomy ［J］.Orthop Surg，2023，15（10）：2602-2611.
6	Zhao C， Zhang H， Wang Y， et al. Nomograms for predicting recurrent herniation in PETD with preoperative radiological factors ［J］.Pain Res，2021：2095-2109.
7	谈俊，胡鹏涛，王毅.脊柱内镜下经椎板间入路腰椎间盘切除术的并发症及防治策略分析［J］.中国内镜杂志，2020，26（7）：83-88.
8	赵俊华，杨政伟，刘阳，等.规范的术后康复训练对PELD术预后的影响［J］.中华老年骨科与康复电子杂志，2023，09（2023）：0263-2096.
9	Sivakanthan S， Hasan S， Hofstetter C. Full-Endoscopic lumbar discectomy［J］.Neurosurg Clin N Am，2020，31（1）：1-7.
10	佟智慧，曲景文，葛茂锁，等.经皮内镜椎间孔入路手术治疗老年腰椎间盘突出症的临床分析［J］.中华老年骨科与康复电子杂志，2019，05（2019）：0263-2096.
11	Giannina L Garcés Ambrossi，Matthew J McGirt，Daniel M Sciubba， et al. Recurrent lumbar disc herniation after single-level lumbar discectomy： incidence and health care cost analysis ［J］. Neurosurgery，2009，65（3）：574-8.
12	Choi KC，Lee JH，Kim JS，et al.Unsuccessful percutaneous endoscopic lumbar discectomy：a single-center experience of 10，228 cases［J］.Neurosurgery，2015，76（4）：372-380；discussion 380-1；quiz 381.
13	白一冰谢明玖&amp；简伟，椎间孔镜治疗复发性腰椎间盘突出症的临床分析，颈腰痛杂志35（2014）.
14	Choi KC， Kim JS， Ryu KS， et al. Percutaneous endoscopic lumbar discectomy for L5-S1 disc herniation： transforaminal versus interlaminar approach［J］.Pain Physician，2013，16（6）：547-556.
15	Kim CH， Chung CK， Jahng TA， et al. Surgical outcome of percutaneous endoscopic interlaminar lumbar diskectomy for recurrent disk herniation after open diskectomy ［J］. J Spinal Disord Tech，2012，25（5）：E125-E133.
16	Shin KH， Chang HG， Rhee NK， et al. Revisional percutaneous full endoscopic disc surgery for recurrent herniation of previous open lumbar discectomy［J］.Asian Spine J，2011，5（1）：1-9.
17	陶晖，张银顺，董福龙，等.经椎板间入路和经椎间孔入路脊柱内镜下治疗L5-S1 椎间盘突出症的临床疗效比较［J］.颈腰痛杂志，2019，40（5）：587-589，594.
18	Ruetten S， Komp M， Merk H， et al. Full-endoscopic interlaminar and transforaminal lumbar discectomy versus conventional microsurgical technique： a prospective， randomized， controlled study ［J］.Spine（Phila Pa 1976），2008，33（9）：931-939.
19	虞攀峰，昝鹏飞，张西峰，等.脊柱内镜下经椎板间入路翻修L5～S1开窗术后复发的早期临床报告［J］.中国骨与关节杂志，2019，8（7）：525-530.
20	C Shi，W Kong，W Liao，［J］.The Early Clinical Outcomes of a Percutaneous Full-Endoscopic Interlaminar Approach via a Surrounding Nerve Root Discectomy Operative Route for the Treatment of Ventral-Type Lumbar Disc Herniation ［J］. Biomed Res Int， 2018，12，2018：9157089.
21	曾娘华.经椎板间入路椎间孔镜下髓核摘除术治疗巨大腰椎间盘突出症的效果分析［J］.颈腰痛杂志，2021，42（6）：866-868.
22	Yu Y，Zhou Q，Xie YZ，et al.Effect of percutaneous endoscopic lumbar foraminoplasty of different facet joint portions on lumbar biomechanics： a finite element analysis ［J］. Orthop Surg， 2020， 12（4）：1277-1284.

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