Efficacy and safety of biportal endoscopic discectomy with annulus fibrosus suture for recurrent lumbar disc herniation_West China Medical Journal

Authors：

GONG Shuangquan , WANG Chenglong ,  CUI Liqiang , LIU Hongjun , YE Yu , XIE Shiming

Minimally Invasive Spine Department, Mianyang Orthopaedic Hospital, Mianyang, Sichuan 621000, P. R. China;

Corresponding?author：

CUI Liqiang, Email: papaya1999@163.com

Keywords：

Unilateral biportal endoscopy; recurrent lumbar disc herniation; annulus fibrosus suture; minimally invasive surgery

DOI：

10.7507/1002-0179.202407046

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Objective To evaluate the clinical efficacy and safety of biportal endoscopic discectomy combined with annulus fibrosus suture in the treatment of recurrent lumbar disc herniation (RLDH). Methods The clinical data of patients with RLDH who underwent biportal endoscopic discectomy combined with annulus fibrosus suture using a single-use suture device at Mianyang Orthopaedic Hospital between May 2020 and July 2022 were retrospectively collected. Visual Analogue Scale (VAS) scores for low back and leg pain and Oswestry Disability Index (ODI) scores on postoperative Day 3 and at the last follow-up were used to assess pain and functional status. Postoperative lumbar CT, MRI, and dynamic X-rays were obtained to evaluate the extent of decompression, disc removal, and spinal stability. Clinical efficacy during follow-up was assessed using the MacNab criteria since postoperative 3 months. Results Twenty-one RLDH patients (16 males, 5 females) with a mean age of (45.14±15.26) years (range: 17-62 years) were included. The involved segments were L₃-L₄ in 1 case, L₄-L₅ in 9 cases, and L₅-S₁ in 11 cases. All surgeries were successfully completed without complications such as nerve injury, symptomatic epidural hypertension, dural tear, cerebrospinal fluid leakage, or infection. All patients were followed up for a mean duration of (11.38±3.51) months (range: 4-17 months). No recurrence of disc herniation or segmental instability was observed during follow-up. Significant improvements were seen in VAS scores for low back pain (2.90±0.70, 1.38±0.81), leg pain (2.33±0.58, 1.29±0.46), and ODI scores [(24.12±5.05)%, (11.29±1.86)%] on postoperative Day 3 and at the last follow-up compared to the preoperative values [5.90±1.09, 6.10±0.77, (57.08±9.72)%; all P<0.05]. According to the MacNab criteria, the clinical efficacy was rated as excellent in 16 cases, good in 3 cases, and fair in 2 cases, yielding an excellent-good rate of 90.5%. Conclusion Biportal endoscopic discectomy with annulus fibrosus suture is a safe and effective treatment for RLDH, demonstrating favourable clinical outcomes and warranting further research and application.

Citation： GONG Shuangquan, WANG Chenglong, CUI Liqiang, LIU Hongjun, YE Yu, XIE Shiming. Efficacy and safety of biportal endoscopic discectomy with annulus fibrosus suture for recurrent lumbar disc herniation. West China Medical Journal, 2025, 40(9): 1376-1381. doi: 10.7507/1002-0179.202407046 Copy

1.	Yao Y, Liu H, Zhang H, et al. Risk factors for recurrent herniation after percutaneous endoscopic lumbar discectomy. World Neurosurg, 2017, 100: 1-6.
2.	Yin S, Du H, Yang W, et al. Prevalence of recurrent herniation following percutaneous endoscopic lumbar discectomy: a meta-analysis. Pain Physician, 2018, 21(4): 337-350.
3.	Shriver MF, Xie JJ, Tye EY, et al. Lumbar microdiscectomy complication rates: a systematic review and meta-analysis. Neurosurg Focus, 2015, 39(4): E6.
4.	胡袒, 鄭超, 伍驥, 等. 內窺鏡下椎間盤切除術治療腰椎間盤突出癥術后復發的影響因素分析. 中國脊柱脊髓雜志, 2015, 25(10): 899-903.
5.	Cheng J, Wang H, Zheng W, et al. Reoperation after lumbar disc surgery in two hundred and seven patients. Int Orthop, 2013, 37(8): 1511-1517.
6.	Li Z, Yang H, Liu M, et al. Clinical characteristics and risk factors of recurrent lumbar disk herniation: a retrospective analysis of three hundred twenty-one cases. Spine (Phila Pa 1976), 2018, 43(21): 1463-1469.
7.	Jia M, Sheng Y, Chen G, et al. Development and validation of a nomogram predicting the risk of recurrent lumbar disk herniation within 6 months after percutaneous endoscopic lumbar discectomy. J Orthop Surg Res, 2021, 16(1): 274.
8.	Yang CH, Chiang YF, Chen CH, et al. The effect of annular repair on the failure strength of the porcine lumbar disc after needle puncture and punch injury. Eur Spine J, 2016, 25(3): 906-912.
9.	Price DD, McGrath PA, Rafii A, et al. The validation of visual analogue scales as ratio scale measures for chronic and experimental pain. Pain, 1983, 17(1): 45-56.
10.	van Hooff ML, Mannion AF, Staub LP, et al. Determination of the Oswestry Disability Index score equivalent to a “satisfactory symptom state” in patients undergoing surgery for degenerative disorders of the lumbar spine-a Spine Tango registry-based study. Spine J, 2016, 16(10): 1221-1230.
11.	Macnab I. Negative disc exploration. An analysis of the causes of nerve-root involvement in sixty-eight patients. J Bone Joint Surg Am, 1971, 53(5): 891-903.
12.	Heo DH, Quillo-Olvera J, Park CK. Can percutaneous biportal endoscopic surgery achieve enough canal decompression for degenerative lumbar stenosis? Prospective case-control study. World Neurosurg, 2018, 120: e684-e689.
13.	Soliman HM. Irrigation endoscopic discectomy: a novel percutaneous approach for lumbar disc prolapse. Eur Spine J, 2013, 22(5): 1037-1044.
14.	Kim JE, Yoo HS, Choi DJ, et al. Comparison of minimal invasive versus biportal endoscopic transforaminal lumbar interbody fusion for single-level lumbar disease. Clin Spine Surg, 2021, 34(2): E64-E71.
15.	Park JH, Jun SG, Jung JT, et al. Posterior percutaneous endoscopic cervical foraminotomy and diskectomy with unilateral biportal endoscopy. Orthopedics, 2017, 40(5): e779-e783.
16.	朱斌, 田大勝, 陳磊, 等. 單邊雙通道內鏡技術在腰椎疾病中的應用研究進展. 中華骨科雜志, 2020, 40(15): 1030-1038.
17.	Alkalay RN, Kim DH, Urry DW, et al. Prevention of postlaminectomy epidural fibrosis using bioelastic materials. Spine (Phila Pa 1976), 2003, 28(15): 1659-1665.
18.	LaRocca H, MacNab I. The laminectomy membrane. Studies in its evolution, characteristics, effects and prophylaxis in dogs. J Bone Joint Surg Br, 1974, 56B(3): 545-550.
19.	Liu J, Ni B, Zhu L, et al. Mitomycin C-polyethylene glycol controlled-release film inhibits collagen secretion and induces apoptosis of fibroblasts in the early wound of a postlaminectomy rat model. Spine J, 2010, 10(5): 441-447.
20.	Guardado AA, Baker A, Weightman A, et al. Lumbar intervertebral disc herniation: annular closure devices and key design requirements. Bioengineering (Basel), 2022, 9(2): 47.
21.	張壯壯, 汪文龍, 劉正. 腰椎纖維環縫合技術的研究進展. 中國骨與關節雜志, 2020, 9(2): 153-156.
22.	馮皓宇, 馬迅, 何李明, 等. 后路椎間植骨融合與椎弓根釘內固定修復復發性腰椎間盤突出癥: 6 個月隨訪. 中國組織工程研究, 2015, 19(9): 1371-1376.
23.	李鵬飛, 趙宗茂, 賈楠, 等. 纖維環縫合對維持髓核摘除后椎間盤生物力學強度的影響. 中華實驗外科雜志, 2018, 35(2): 297-299.
24.	Carragee EJ, Han MY, Suen PW, et al. Clinical outcomes after lumbar discectomy for sciatica: the effects of fragment type and anular competence. J Bone Joint Surg Am, 2003, 85(1): 102-108.
25.	Bailey A, Araghi A, Blumenthal S, et al. Prospective, multicenter, randomized, controlled study of anular repair in lumbar discectomy: two-year follow-up. Spine (Phila Pa 1976), 2013, 38(14): 1161-1169.
26.	De Antoni DJ, Claro ML, Poehling GG, et al. Translaminar lumbar epidural endoscopy: anatomy, technique, and indications. Arthroscopy, 1996, 12(3): 330-334.
27.	朱承躍, 張良平, 程偉, 等. 單側雙通道脊柱內鏡下髓核摘除術聯合纖維環縫合術治療腰椎間盤突出癥早期臨床療效. 中國修復重建外科雜志, 2022, 10(10): 1186-1191.

1. Yao Y, Liu H, Zhang H, et al. Risk factors for recurrent herniation after percutaneous endoscopic lumbar discectomy. World Neurosurg, 2017, 100: 1-6.
2. Yin S, Du H, Yang W, et al. Prevalence of recurrent herniation following percutaneous endoscopic lumbar discectomy: a meta-analysis. Pain Physician, 2018, 21(4): 337-350.
3. Shriver MF, Xie JJ, Tye EY, et al. Lumbar microdiscectomy complication rates: a systematic review and meta-analysis. Neurosurg Focus, 2015, 39(4): E6.
4. 胡袒, 鄭超, 伍驥, 等. 內窺鏡下椎間盤切除術治療腰椎間盤突出癥術后復發的影響因素分析. 中國脊柱脊髓雜志, 2015, 25(10): 899-903.
5. Cheng J, Wang H, Zheng W, et al. Reoperation after lumbar disc surgery in two hundred and seven patients. Int Orthop, 2013, 37(8): 1511-1517.
6. Li Z, Yang H, Liu M, et al. Clinical characteristics and risk factors of recurrent lumbar disk herniation: a retrospective analysis of three hundred twenty-one cases. Spine (Phila Pa 1976), 2018, 43(21): 1463-1469.
7. Jia M, Sheng Y, Chen G, et al. Development and validation of a nomogram predicting the risk of recurrent lumbar disk herniation within 6 months after percutaneous endoscopic lumbar discectomy. J Orthop Surg Res, 2021, 16(1): 274.
8. Yang CH, Chiang YF, Chen CH, et al. The effect of annular repair on the failure strength of the porcine lumbar disc after needle puncture and punch injury. Eur Spine J, 2016, 25(3): 906-912.
9. Price DD, McGrath PA, Rafii A, et al. The validation of visual analogue scales as ratio scale measures for chronic and experimental pain. Pain, 1983, 17(1): 45-56.
10. van Hooff ML, Mannion AF, Staub LP, et al. Determination of the Oswestry Disability Index score equivalent to a “satisfactory symptom state” in patients undergoing surgery for degenerative disorders of the lumbar spine-a Spine Tango registry-based study. Spine J, 2016, 16(10): 1221-1230.
11. Macnab I. Negative disc exploration. An analysis of the causes of nerve-root involvement in sixty-eight patients. J Bone Joint Surg Am, 1971, 53(5): 891-903.
12. Heo DH, Quillo-Olvera J, Park CK. Can percutaneous biportal endoscopic surgery achieve enough canal decompression for degenerative lumbar stenosis? Prospective case-control study. World Neurosurg, 2018, 120: e684-e689.
13. Soliman HM. Irrigation endoscopic discectomy: a novel percutaneous approach for lumbar disc prolapse. Eur Spine J, 2013, 22(5): 1037-1044.
14. Kim JE, Yoo HS, Choi DJ, et al. Comparison of minimal invasive versus biportal endoscopic transforaminal lumbar interbody fusion for single-level lumbar disease. Clin Spine Surg, 2021, 34(2): E64-E71.
15. Park JH, Jun SG, Jung JT, et al. Posterior percutaneous endoscopic cervical foraminotomy and diskectomy with unilateral biportal endoscopy. Orthopedics, 2017, 40(5): e779-e783.
16. 朱斌, 田大勝, 陳磊, 等. 單邊雙通道內鏡技術在腰椎疾病中的應用研究進展. 中華骨科雜志, 2020, 40(15): 1030-1038.
17. Alkalay RN, Kim DH, Urry DW, et al. Prevention of postlaminectomy epidural fibrosis using bioelastic materials. Spine (Phila Pa 1976), 2003, 28(15): 1659-1665.
18. LaRocca H, MacNab I. The laminectomy membrane. Studies in its evolution, characteristics, effects and prophylaxis in dogs. J Bone Joint Surg Br, 1974, 56B(3): 545-550.
19. Liu J, Ni B, Zhu L, et al. Mitomycin C-polyethylene glycol controlled-release film inhibits collagen secretion and induces apoptosis of fibroblasts in the early wound of a postlaminectomy rat model. Spine J, 2010, 10(5): 441-447.
20. Guardado AA, Baker A, Weightman A, et al. Lumbar intervertebral disc herniation: annular closure devices and key design requirements. Bioengineering (Basel), 2022, 9(2): 47.
21. 張壯壯, 汪文龍, 劉正. 腰椎纖維環縫合技術的研究進展. 中國骨與關節雜志, 2020, 9(2): 153-156.
22. 馮皓宇, 馬迅, 何李明, 等. 后路椎間植骨融合與椎弓根釘內固定修復復發性腰椎間盤突出癥: 6 個月隨訪. 中國組織工程研究, 2015, 19(9): 1371-1376.
23. 李鵬飛, 趙宗茂, 賈楠, 等. 纖維環縫合對維持髓核摘除后椎間盤生物力學強度的影響. 中華實驗外科雜志, 2018, 35(2): 297-299.
24. Carragee EJ, Han MY, Suen PW, et al. Clinical outcomes after lumbar discectomy for sciatica: the effects of fragment type and anular competence. J Bone Joint Surg Am, 2003, 85(1): 102-108.
25. Bailey A, Araghi A, Blumenthal S, et al. Prospective, multicenter, randomized, controlled study of anular repair in lumbar discectomy: two-year follow-up. Spine (Phila Pa 1976), 2013, 38(14): 1161-1169.
26. De Antoni DJ, Claro ML, Poehling GG, et al. Translaminar lumbar epidural endoscopy: anatomy, technique, and indications. Arthroscopy, 1996, 12(3): 330-334.
27. 朱承躍, 張良平, 程偉, 等. 單側雙通道脊柱內鏡下髓核摘除術聯合纖維環縫合術治療腰椎間盤突出癥早期臨床療效. 中國修復重建外科雜志, 2022, 10(10): 1186-1191.

West China Medical Journal

Efficacy and safety of biportal endoscopic discectomy with annulus fibrosus suture for recurrent lumbar disc herniation

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