Efficacy of Repeat Percutaneous Endoscopic Lumbar Decompression for Reoperation of Lumbar Spinal Stenosis: A Retrospective Study

Figures & data

Table 1 Demographic Features of Patients

Characteristic	Mean ± SD or n (%)
Age, years	63.5±14.1
Sex
Female	12 (50%)
Male	12 (50%)
Duration of symptoms, months	10.9 ± 5.9
Type of stenosis
Central stenosis	9 (37.5%)
Lateral recess stenosis	8 (33.3%)
Central combined with Lateral recess stenosis	7 (29.2%)
Operative level
L3-4	1 (4.2%)
L4-5	19 (79.2%)
L5-S1	4 (16.6%)
Follow-up, months	35.5 ± 11.0
Blood loss, mL	12.5 ± 5.3
Operative time, minutes	122.3 ± 29.2
Hospital stays, days	7.0 ± 1.9

Figure 1 Illustrative case of a 49-year-old woman with lumbar spinal stenosis (LSS), who underwent initial surgery on the left side and reoperation on the right side. Initial preoperative sagittal computed tomography (CT) (A1), sagittal magnetic resonance imaging (MRI) (A2), axial CT (A3) and axial MRI (A4). Initial postoperative sagittal CT (B1), sagittal MRI (B2), axial CT (B3) and axial MRI (B4). The second postoperative sagittal CT (C1), sagittal MRI (C2), axial CT (C3) and axial MRI (C4). The second postoperative sagittal CT (D1), sagittal MRI (D2), axial CT (D3) and axial MRI (D4). Endoscopy showed that the nerve roots and dura were relatively smooth during the reoperation, without obvious scarring (E1) and decompression completion (E2).

Abbreviations: NRT, nerve root; PLL, posterior longitudinal ligament; Lig. Flavum, Flavum ligament.

Figure 2 An illustrative case of an 85-year-old woman with lumbar spinal stenosis (LSS) who underwent ipsilateral (right-sided) reoperation. The first preoperative sagittal computed tomography (CT) (A1), sagittal magnetic resonance imaging (MRI) (A2), axial CT (A3) and axial MRI (A4). The second postoperative sagittal CT (B1), sagittal MRI (B2), axial CT (B3) and axial MRI (B4). The second postoperative sagittal CT (C1), sagittal MRI (C2), axial CT (C3) and axial MRI (C4). Endoscopy showed significant scar formation and adhesion of nerve roots and peridural area during resurgery (D1), and completion of decompression (D2).

Abbreviations: NRT, nerve root; Lig. Flavum, flavum ligament.

Table 2 Postoperative Modified MacNab Criteria and Outcomes

Outcome	Description	N (%)
Excellent	Complete relief of symptoms	8 (33.3%)
Good	Marked improvement but occasional pain	12 (50.0%)
Fair	Improved functional capacity and the need for pain medications	3 (12.5%)
Poor	Unimproved symptoms or worsening	1 (4.2%)

Table 3 Clinical Outcomes of Percutaneous Endoscopic Lumbar Decompression (PELD) Reoperation

	Preoperative	3 Months	6 Months	1 Year	2 Years	Final Follow-Up
ODI (%)	68.9 ± 6.0	27.0 ± 4.4*	25.5 ± 4.3*	23.6 ± 5.2*	22.0 ± 5.5*	20.9 ± 5.6*
VAS (Leg)	6.1 ± 1.0	2.3 ± 1.0*	2.3 ± 1.3*	2.1 ± 1.1*	2.0 ± 1.0*	2.0 ± 1.2*
VAS (Back)	6.2 ± 0.8	2.7 ± 1.2*	2.5 ± 1.3*	2.4 ± 1.0*	2.3 ± 1.0*	2.1 ± 1.1*

Note: *P <0.05, compared with preoperative data.

Abbreviations: ODI, Oswestry disability index; VAS, visual analog scale pain score.

Table 4 Comparation Between Ipsilateral and Contralateral

	Ipsilateral (n=13)	Contralateral (n=11)	P
Preoperative
ODI	71.23±6.085	66.09±4.888	0.0347
VAS-L	6.15±0.899	6.00±1.095	0.7158
VAS-B	6.15±0.801	6.27±0.905	0.7336
Final follow-up
ODI	22.54±5.190	18.91±5.629	0.1147
VAS-L	2.23±1.092	1.818±1.250	0.3979
VAS-B	2.00±1.155	2.27±1.009	0.552
Macnab			0.115
Excellent	2 (15.38%)	5 (50%)
Good	9 (69.23%)	3 (30%)
Fair	1 (7.69%)	2 (20%)
Poor	1 (7.69%)	0 (0%)

Note: P <0.05, compared with Ipsilateral data.

Abbreviations: ODI, Oswestry Disability Index; VAS, visual analog pain score.

Table 5 Complications of Percutaneous Endoscopic Lumbar Decompression (PELD) Reoperation

	N (%)
Hematoma	1 (4.2%)
Nerve root injury	1 (4.2%)
Dural injury	2 (8.3%)