• Jung Hwan Lee, Kyung-Chul Choi, and Lee Jun Ho JH Department of Neurosurgery, Kyung Hee University Medical Center, Dong Dae Mun Gu, Seoul, South Korea. Electronic address: moo9924@khu.ac.kr..
• Department of Rehabilitation Medicine, Namdarun Rehabilitation Clinic, Yong In City, Gyeonggi-Do, South Korea.
• World Neurosurg. 2019 Dec 1; 132: e623-e629.

ObjectiveTo explore which preoperative radiologic variables have propensity for reherniation and to evaluate whether the inherent annulus splitting procedure during percutaneous endoscopic lumbar diskectomy (PELD) could prompt reherniation, we assessed the correlation between the anatomic location of annular penetration and reherniation.MethodsThree hundred and fifty patients who underwent PELD for central or subarticular disk herniation through a transforaminal approach were followed-up for at least 24 months. Fifty-four subjects that were reoperated for recurrent herniation were allocated as the reherniation group and the other 296 subjects were allocated as the non-reherniation group. The numerical rating scale score, another lumbosacral disk herniation (LDH) lesion in addition to the PELD level (another LDH), location (central or subarticular) and severity of LDH (protrusion or extrusion), and tear of the posterior longitudinal ligament (PLL) were compared between the 2 groups to identify which variables could be predictive factors for reherniation. To assess the influences of PELD on reherniation, location and severity of reherniation were compared with those of initial herniation.ResultsThe location at the subarticular region and the existence of a concomitant PLL tear during initial LDH were significantly related to subsequent reherniation. The location and severity of these reherniations were significantly retained when compared with those of primary herniation.ConclusionsPLL tear and subarticular herniation were significantly related to recurrent disk herniation. Reherniation patterns after PELD generally matched those of primary herniation. The annulus penetrating step during PELD did not increase the risk of reherniation.Copyright © 2019 Elsevier Inc. All rights reserved.

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