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Subject Area

Degenerative, Minimally invasive procedures

Document Type

Case Report

Abstract

Background Data: Recurrence of LDH has been reported in 5%–11% of patients after conventional discectomy, and most of these patients are usually treated with repeated discectomy through the same initial approach. Tubular microdiscectomy is an increasingly popular surgery for lumbar disc prolapse and has replaced conventional open surgery in the last decade. However, it requires more experience and has a steep learning curve, especially in revision cases.

Purpose: We present the findings of a tubular lumbar microdiscectomy performed after two conventional open laminectomies and discectomies, explaining the challenges and difficulties in such cases and leading the way for the use of minimally invasive spine surgeries after multiple open surgeries.

Study Design: Case report and literature review.

Patients and Methods: A middle-aged man who had undergone two open laminectomies and discectomies several years ago at L5-S1 and fenestrated laminectomy at L4-L5 presented with new radiculopathy over the S1 nerve root dermatome to which a new tubular microdiscectomy was performed.

Results: The patient ran a smooth postoperative course, and his symptoms improved.

Conclusion: Tubular microdiscectomy achieves the goal of fixation, is cost-effective, and goes with the patient preference. A successful tubular microdiscectomy is tough to accomplish after two spinal surgeries around and near the same involved spinal nerve. Despite that, this case report shows the good outcomes that this type of surgery can achieve, hinting that minimally invasive spine surgery (MISS) application is not limited to primary cases but can include redo surgeries for such conditions. However, it should be borne in mind that a successful redo surgery requires proper preoperative clinical and radiological assessment. (2021ESJ252)

Keywords

lumbar spine, endoscopy, recurrent disc herniation

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