Revision Surgery after Percutaneous Endoscopic Transforaminal Discectomy Compared with Primary Open Surgery for Symptomatic Lumbar Degenerative Disease

OBJECTIVE: To evaluate the clinical outcome of reoperation after percutaneous endoscopic lumbar discectomy (PELD) as compared with primary spinal decompression and fusion. Fisher's exact test was used for small data subsets. RESULTS: There was no statistically significant difference between the two groups in mean age (52.7 years vs 52.9 years), gender ratio (6 men-to-7 women vs 12 men-to-14 women), body mass index, medical history, preoperative diagnosis, or surgical spine level (P > 0.05). The mean operative time of the revision surgery group was significantly longer than that of the primary open surgery group (160.0 min vs 130.2 min, P < 0.05). The revision surgery group also had a significantly higher mean estimated blood loss, postoperative drainage, and length of hospital stay (P < 0.05). However, no significant differences were found between the two groups in terms of hemoglobin and hematocrit values, preoperatively and postoperatively. The rate of transitional neurological irritation was higher in the revision surgery group (61.5% vs 3.8%; P < 0.05), as was intraoperative durotomy and cerebrospinal fluid leakage (30.8% vs 3.8%, P < 0.05). At 1 month, the VAS and ODI scores of the primary open surgery group were significantly better than those of the revision surgery group, while the improvement in JOA scores was similar. After 6 and 12 months' follow-up, the VAS and ODI scores and the rates of JOA improvement were comparable. CONCLUSION: Patients with LDD who received primary spinal decompression and fusion experienced lower rates of perioperative complications and shorter hospitalization compared with patients who underwent revision surgery after PELD, but the clinical outcomes at the last follow-up of both groups were satisfactory.