Patient-Reported Outcomes in Recurrent Lumbar Disc Herniation Surgery: Clinical Results and a Decision-Making Algorithm for Endoscopic Technique Selection

Objective

To compare clinical outcomes and patient-reported measures between primary and revision full-endoscopic lumbar discectomy (FELD) in patients with lumbar disc herniation and to propose a decision-making algorithm for selecting the endoscopic surgical approach in revision cases.

Methods

This retrospective study included 843 patients undergoing FELD at a single center: 742 for primary herniation and 101 for recurrent herniation. Patients with >6 months follow-up were assessed. Outcomes included visual analog scale (VAS) for leg and back pain, Oswestry Disability Index, 12-Item Short Form Health Survey (physical and mental component scores), and patient satisfaction. Statistical comparisons and analysis of covariance adjustments were performed to control for baseline differences.

Results

Both groups showed significant and comparable improvements in leg pain, back pain, disability, and quality of life. Final follow-up scores were slightly higher (worse) in the recurrent group (adjusted differences: VAS leg +0.66, VAS back +0.71, Oswestry Disability Index +4.72; all P < 0.05), though changes from baseline were not significantly different. Complication and reoperation rates were low and similar in both groups (∼2%). Patient satisfaction was slightly lower in the recurrent group (excellent/good: 77.6% vs. 92%, P = 0.0001). The transforaminal approach was favored in revision cases to avoid scar tissue, contributing to the low complication rate.

Conclusion

FELD is a safe and effective technique for recurrent lumbar disc herniation, yielding clinical outcomes comparable to primary discectomy. Slightly lower satisfaction in revision cases suggests the importance of managing expectations. An algorithmic approach to endoscopic technique selection may optimize outcomes in revision settings.