Transforaminal endoscopic removal of recurrent lumbar disc extrusion after prior microdiscectomy: a case series analysis and literature review

Objective. To evaluate the clinical efficacy of transforaminal endoscopic discectomy (TESSYS) for recurrent lumbar disc herniation initially removed by microdiscectomy.

Material and Methods. A retrospective observational case series study (n = 24) was performed. In 2024–2025, patients with recurrent disc herniation at L4–L5 (n = 14) or L5–S1 (n = 10) level underwent transforaminal endoscopic removal of the herniation (TESSYS). Recurrence was defined as repeated detection of herniated material at the same level and side with recurrence of radicular symptoms after a period of clinical improvement of 1 month or more. Outcomes were assessed using VAS (back and leg pain), ODI and MRC before surgery, at discharge, and after 3 and 12 months. Achievement of MCID for ODI, length of hospital stay, and complications were analyzed.

Results. The average age of patients was 48.3±11.0 years, and length of hospital stay was 1.46±0.66 days. Statistically significant improvement in VAS and ODI was observed at all follow-up stages (p < 0.001). By 12 months the VAS score for back pain decreased from 6.21±1.50 to 0.75±0.85, and for leg pain – from 6.92±1.06 to 0.38±1.06. The ODI score decreased from 58.50±14.08% to 4.54±7.56% by 12 months; MCID was achieved in 100% of patients. Muscle strength (MRC) increased from 4.00±1.29 to 4.71±0.69 by 12 months. No intraoperative complications (nerve root injury, dural tear, infection) were observed. In two patients (8.3%), transient paresthesia/dysesthesia was identified and resolved conservatively within 2 weeks; in one patient (4.2%), a recurrence at 10 months required decompression and stabilization surgery.

Conclusion. In the presented series, TESSYS demonstrated high clinical efficacy and safety for recurrent disc herniation; however, this interpretation is limited by the small sample size and the lack of own control group.

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