Is Transforaminal Endoscopic Discectomy the Best Option for Recurrent Lumbar Disc Herniation? A Systematic Review

Introduction: Recurrent lumbar disc herniation (rLDH) remains a challenge in spinal surgery. This systematic review analyzes the use of transforaminal endoscopic discectomy (TFED) for the treatment of rLDH. Methods: A comprehensive search of 4 electronic databases, including PubMed, Google Scholar, Science Direct, and Cochrane, was conducted. Studies that analyzed the use of TFED to manage rLDH were included in the review. The primary outcomes assessed in these studies encompassed postoperative complications, length of surgery, blood loss, duration of hospitalization, pain scores, and recurrence rates. Results: Six studies met the inclusion criteria, comprising 405 patients. The mean duration of surgery was 24 to 158.74 minutes with intraoperative estimated blood loss of 0 to 34.8 mL. The mean recurrence rate was 4.4% with a 0.7% progression to fusion during the follow-up period. Durotomy was seen in 2.7% of cases. There was a 0.1% incidence of temporary nerve irritation with no permanent nerve injuries reported. Conclusions: TFED for the management of rLDH is a lateral minimally invasive technique that avoids going through scar tissue, hence associated with a short duration of surgery, minimal to no measurable blood loss, and a very low complication rate. The few studies in the literature seem to suggest that TFED should be considered in patients with rLDH without segmental instability who meet the criteria for surgery. Level of Evidence: 5.