Journal of Craniovertebral Junction and Spine

ABSTRACT\r\n Background: The management of recurrent lumbar disc herniation (rLDH) lacks a consensus. Consequently, the choice between repeat \r\nmicrodiscectomy (MD) without fusion, discectomy with fusion, or endoscopic discectomy without fusion typically hinges on the surgeon’s \r\nexpertise. This study conducts a comparative analysis of postoperative outcomes among these three techniques and proposes a straightforward \r\nclassification system for rLDH aimed at optimizing management.\r\n Patients and Methods: We examined the patients treated for rLDH at our institution. Based on the presence of facet resection, Modic‑2 \r\nchanges, and segmental instability, they patients were categorized into three groups: Types I, II, and III rLDH managed by repeat MD without \r\nfusion, MD with transforaminal lumbar interbody fusion (TLIF) (MD + TLIF), and transforaminal endoscopic discectomy (TFED), respectively.\r\n Results: A total of 127 patients were included: 52 underwent MD + TLIF, 50 underwent MD alone, and 25 underwent TFED. Recurrence rates \r\nwere 20%, 12%, and 0% for MD alone, TFED, and MD + TLIF, respectively. A facetectomy exceeding 75% correlated with an 84.6% recurrence risk, \r\nwhile segmental instability correlated with a 100% recurrence rate. Modic‑2 changes were identified in 86.7% and 100% of patients experiencing \r\nrecurrence following MD and TFED, respectively. TFED exhibited the \r\nlowest risk of durotomy (4%), the shortest operative time (70.80 ± 16.5), \r\nthe least blood loss (33.60 ± 8.1), and the most favorable Visual Analog \r\nScale score, and Oswestry Disability Index quality of life assessment at \r\n2 years. No statistically significant differences were observed in these \r\nparameters between MD alone and MD + TLIF. Based on this analysis, \r\na novel classification system for recurrent disc herniation was proposed.\r\n Conclusion: In young patients without segmental instability, prior \r\nfacetectomy, and Modic‑2 changes, TFED was available should \r\ntake precedence over repeat MD alone. However, for patients with \r\nsegmental instability, MD + TLIF is recommended. The suggested \r\nclassification system has the potential to enhance patient selection \r\nand overall outcomes.\r\n Keywords: Endoscopic discectomy, facetectomy, \r\nmicrodiscectomy, Modic changes, segmental instability, \r\ntransforaminal lumbar interbody fusion