Hsi-Kai TsouTaichung Veterans General Hospital, Taiwan
Title: Comparison of clinical outcomes after microdiscectomy with interspinous process device or interlaminar device implantation for lumbar spinal stenosis and using percutaneous endoscopic lumbar discectomy for those with recurrent lumbar disc herniation
Lumbar spinal stenosis (LSS) comprises narrowing of the spinal canal with subsequent neural compression. The indications of interspinous process devices (IPDs) were lumbar stenosis, lumbar herniated disc and mechanical lower back pain. Interlaminar stabilization devices (ILDs) were introduced for similar indications more than 10 years ago. The purpose of this paper is to compare the clinical outcomes between IPDs and ILDs groups, and using percutaneous endoscopic lumbar discectomies (PELD) for those with recurrent lumbar disc herniation after microdiscectomies with IPDs/ILDs.
From May 2009 to Jan. 2014, 135 cases with single to three levels lumbar disc herniation (total 171 levels) were treated with minimally invasive decompressed procedure (microlaminotomy with discectomy) with IPDs implantation (Wallis, Abbott Spine, USA). From Oct. 2014 to Jul. 2021, 169 cases with single to three levels lumbar disc herniation (total 252 levels) were treated with minimal invasive decompressed procedure (microlaminotomy with discectomy) with ILDs implantation (IntraSPINE, Cousin, France).
In the Wallis IPDs group, 6 cases (6/135, 4.4%) of recurrent lumbar disc herniation were found according to the recurrent symptoms and MRI study. The mean age at the first operation was 52 (26-84). The mean recurrent period after the first operation was 6.1 months (0.75-12 months). In the IntraSPINE group, 3 cases (3/169, 1.8%) had recurrent lumbar disc herniation. The mean age at the first operation was 66.45 (29-89). The mean recurrent period after the first operation was 8.5 months (1.5-18 months). PELD was performed for those patients with recurrence by the same neurosurgeon.
IPDs/ILDs were developed for dynamic stabilization of lumbar segments following minimally invasive decompression procedures. Recurrent lumbar disc herniation might occur even when IPDs/ILDs are used. PELD is a good treatment of choice for this recurrent disease in selected patients.
Hsi-Kai Tsou is a neurosurgeon who graduated from the National Defense Medical Center, Taipei, Taiwan, ROC in 1994. He is currently working for the Taichung Veterans General Hospital. He earned his doctorate from the Department of Materials Science and Engineering, Feng Chia University, Taichung, Taiwan, ROC in 2013. In 2014 he was named chief of the Functional Neurosurgery Division, Neurological Institute, Taichung Veterans General Hospital. In 2015 he was named associate professor, Department of Rehabilitation, Jen-Teh Junior College of Medicine, Nursing and Management, Miaoli County, Taiwan, ROC. From Jul. to Aug.,2007 he was a clinical fellow at the UCLA Comprehensive Spine Center, California, USA. He was also a short-term observer at Johns Hopkins University Hospital and Rush University Medical Center, USA in 2006 and 2011, respectively. He served as the Standing Supervisor, Director and Secretary-General of the Taiwan Society of Minimal Invasive Spinal Surgery. He focuses on C-T-L-S spinal surgery, navigation and minimally invasive spinal surgery, spinal radiofrequency procedures, spinal endoscopic surgery and biomedical materials for orthopaedic device coatings. He has published more than 60 SCI papers and two book chapters. He is currently serving on the editorial board of the “BMC Musculoskeletal Disorders” and “World Journal of Orthopedics”.