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, 郑超, 伍骥, 等. 内窥镜下椎间盘切除术治疗腰椎间盘突出症术后复发的影响因素分析. 中国脊柱脊髓杂志, 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, 田大胜, 陈磊, 等. 单边双通道内镜技术在腰椎疾病中的应用研究进展. 中华骨科杂志, 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.	张壮壮, 汪文龙, 刘正. 腰椎纤维环缝合技术的研究进展. 中国骨与关节杂志, 2020, 9(2): 153-156.
22.	冯皓宇, 马迅, 何李明, 等. 后路椎间植骨融合与椎弓根钉内固定修复复发性腰椎间盘突出症: 6 个月随访. 中国组织工程研究, 2015, 19(9): 1371-1376.
23.	李鹏飞, 赵宗茂, 贾楠, 等. 纤维环缝合对维持髓核摘除后椎间盘生物力学强度的影响. 中华实验外科杂志, 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.	朱承跃, 张良平, 程伟, 等. 单侧双通道脊柱内镜下髓核摘除术联合纤维环缝合术治疗腰椎间盘突出症早期临床疗效. 中国修复重建外科杂志, 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, 郑超, 伍骥, 等. 内窥镜下椎间盘切除术治疗腰椎间盘突出症术后复发的影响因素分析. 中国脊柱脊髓杂志, 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, 田大胜, 陈磊, 等. 单边双通道内镜技术在腰椎疾病中的应用研究进展. 中华骨科杂志, 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. 张壮壮, 汪文龙, 刘正. 腰椎纤维环缝合技术的研究进展. 中国骨与关节杂志, 2020, 9(2): 153-156.
22. 冯皓宇, 马迅, 何李明, 等. 后路椎间植骨融合与椎弓根钉内固定修复复发性腰椎间盘突出症: 6 个月随访. 中国组织工程研究, 2015, 19(9): 1371-1376.
23. 李鹏飞, 赵宗茂, 贾楠, 等. 纤维环缝合对维持髓核摘除后椎间盘生物力学强度的影响. 中华实验外科杂志, 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. 朱承跃, 张良平, 程伟, 等. 单侧双通道脊柱内镜下髓核摘除术联合纤维环缝合术治疗腰椎间盘突出症早期临床疗效. 中国修复重建外科杂志, 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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