gms | German Medical Science

Objective: In an effort to prevent open surgery, minimally invasive techniques have been developed. Absence of reherniation is one of the best factors correlated with good clinical outcomes. Therefore, the number of subsequent surgeries after Dekompressor (PLDD) is of great importance. The aim of this study was to investigate the frequency of an additional open surgery after PLDD in a more than ten years' retrospective analysis. Time between PLDD and open surgery was analyzed and a correlation to the clinical symptoms and the outcome was assessed.

Methods: Retrospective observational study. Consecutive patients after PCN between 2005 and 2007 were included. The patient's satisfaction was evaluated with McNab’s outcome criteria. The necessity of an additional open surgery, the period between PLDD and reoperation, and the symptoms were analyzed.

Results: 133 patients were included. The majority of the patients (76.7%) had additional radicular pain. The follow-up time was longer than 5 years in 30.1% and longer than 10 years in 6.82%. The short-term success rate was 67.1%. Subsequent surgery was performed in 28.8% of the patients, 89.5% during the first year. These patients had a significant worse outcome (23.5% versus 75.0%). Radicular pain was present in all patients with early surgery, but only in 50 % of patients with late surgery. Patients with radicular pain were more often involved in subsequent surgery compared to patients with back pain only (33.9% versus 11.8%). Significantly more patients with radicular pain (91.7% versus 69.4 %) had bad results.

Conclusion: 67% patient satisfaction was observed after one month. This result is worsened due to a re-surgery rate of 30%. Subsequent surgery short time after PLDD suggest that PLDD is not a replacement of open discectomy. Because patients with radicular pain had a worse outcome and more frequent re-surgeries it should be discussed if radicular pain is an ideal indication.