Biportal Endoscopic Technique versus Open Microdiscectomy for Recurrent Lumbar Disc Herniation: A Retrospective Comparative Study.

Abstract

Recurrent lumbar disc herniation (RLDH) is defined as herniation occurring at the same disc level following a primary discectomy after a pain-free period of more than 6 months. Repeated open lumbar microdiscectomy (OLM) is frequently advised for RLDH if instability is absent, but scar tissue complicates these surgeries, increasing the risk of dural tears and nerve damage. The biportal endoscopic (BE) technique, a minimally invasive approach, offers potential advantages in managing these challenges. This retrospective review included patients who underwent BE or OLM surgery between January 2020 and July 2023. Only patients with prior surgery at the same level and side were included. Demographic data, preoperative and postoperative pain scores, Oswestry Disability Index scores, MacNab scores, and postoperative complications were analyzed. Statistical analyses were performed, with significance set at P < 0.05. Eighty-two patients were included: 51 underwent OLM and 31 underwent BE. There were no significant differences between groups regarding gender, side, and level of pathology. Both groups showed significant improvement in visual analog scale and Oswestry Disability Index scores postoperatively. The BE group experienced less early postoperative back pain (P = 0.025) and a shorter hospital stay (21 vs. 36 hours, P = 0.0001). However, the OLM group had lower postoperative leg pain (P = 0.003). Complication rates were similar between groups, with no significant differences in recurrence or MacNab scores. The BE technique for RLDH offers comparable outcomes to OLM, with advantages in reduced early postoperative back pain and shorter hospital stays. The high magnification and dynamic handling of the BE technique make it a viable alternative for revision surgeries. Further studies with larger sample sizes and longer follow-up periods are needed to validate these findings.