Introduction: Revision lumbar discectomy is a difficult clinical entity to treat. Historically, complication rates are far higher than first time microdiscectomy resulting in significant morbidity and increased health care costs. Previous reports show minimally invasive tubular discectomy (MITD) to be an equivalent treatment when compared with traditional approaches and previous authors suggest MITD may prove the preferred technique in experienced hands.
Methods: Over an eight year period the senior author performed minimally invasive tubular discectomies on 50 patients with single level lumbar recurrent disc herniations. Surgical technique, outcome, and complication rate are reported and compared to similar patient series in the literature. One case is reviewed and the technique is described in detail.
Results: Average age for the patient population was 50.5 years and ranged from 22-82. There were 29 male and 21 female patients. Post operative patient visit data revealed good to excellent outcomes sustained over time. There were no post operative complications, including dural tears or post-operative wound infections. This is below any reported series of this size to date.
Conclusions: Microscopic minimally invasive tubular discectomy can be safely performed for revision discectomies with low morbidity. Using a paramedian approach helps to decrease the exposure to pre-existing scar tissue and offers significant advantage over the traditional midline approach to treat recurrent disc herniations.
Patient Care: It will offer an efficacious and safe approach to the treatment of recurrent disc herniation. Intraoperative video will be provided.
Learning Objectives: By the conclusion of this session participants should have thorough knowlege of the author's technique for minimally invasive tubular discectomy for recurrent lumbar disc herniation, as well as an understanding of the possible benefits of this technique over conventional approaches.
References: 1. Sandhu FA, Voyadzis JM, Fessler RG. Decision Making for minimally Invasive Spine Surgery Theime Medical Publishers Inc. 2011
2. O-Toole JE, Eichholz KM, Fessler RG. Surgical site infection rates after minimally invasive spine surgery. Journal of Neurosurgery: Spine. 2009 October
3. Smith JS, Ogden AT, Shafizadeh S, Fessler RG. Clinical outcomes after microendoscopic discectomy for recurrent lumbar disc herniation. Journal of Spinal Disorders and Techniques 2010 February