2025 Volume 16 Issue 1 Pages 23-32
Introduction: The superiority of transforaminal full-endoscopic lumbar discectomy (TELD) has been reported while resecting recurrent herniated discs and avoiding adhesion scars after surgery using a posterior approach. However, limitations associated with TELD during revision surgery for lumbar disk herniation (LDH) remain unclear.
Methods: A total of 131 patients with LDH who underwent TELD in revision surgery at L4-5 level participated in the study. Complete removal of the herniated disc was evaluated using lumbar magnetic resonance imaging performed early following surgery, and the clinical results were evaluated retrospectively. Furthermore, we compared these findings with the clinical outcomes of 420 patients who underwent primary surgery.
Results: Among the reoperated cases, complete removal of the herniated disc was observed in 77.1%, postoperative recurrence was observed in 19.8%, and postoperative reoperation was necessary in 19.8%. Postoperative complications occurred in 9.9% of the patients, and the patient satisfaction rate was 81.7% according to the modified Macnab criteria. Considerable differences in complete removal of the herniated disc, postoperative visual analog scale score for leg pain, postoperative Japanese Orthopaedic Association score, postoperative reoperation rate, postoperative complication rate, and patient satisfaction rate were recognized by comparing reoperation and primary operation cases.
Conclusions: TELD was effective in cases undergoing reoperation for LDH. However, the clinical outcomes of revision surgery were substantially inferior to those after primary surgery. Surgeons must be careful to recognize three important factors associated with TELD while performing revision surgery, including accurate identification of the posterior longitudinal ligament, detachment of adhesions, and the need to obtain sufficient decompression.
