Incidence of Recurrence of Lumbar Disc Herniation following Endoscopic Discectomy

Abstract

Background: Lumbar disc herniation is a principal cause of lumbar radiculopathy and disability. Endoscopic discectomy has emerged as a minimally invasive surgical alternative to conventional microdiscectomy; however, prospective outcome data, particularly regarding post-operative recurrence, remain absent from Pakistan's provincial healthcare literature.

Objective: To determine the six-month incidence of symptomatic recurrent lumbar disc herniation following endoscopic discectomy at Khairpur Medical College Hospital (KMCH), Sindh, Pakistan, and to evaluate associated pain and functional outcomes.

Methods: A prospective cohort study enrolled 180 patients aged 18–60 years undergoing percutaneous endoscopic lumbar discectomy and percutaneous endoscopic transforaminal discectomy for single-level LDH between 2024 and 2025. Follow-up was conducted at 6 weeks, 3 months, and 6 months. The primary outcome was MRI-confirmed symptomatic recurrence; secondary outcomes were Visual Analogue Scale for leg pain and Oswestry Disability Index.

Results: Symptomatic recurrence occurred in 11 of 180 patients (6.1%; 95% CI: 3.1–10.7%). Mean time to recurrence was 3.2 months. VAS improved from 7.8 ± 1.1 to 2.1 ± 0.9, and ODI from 62.4% to 18.3% at six months (both p < 0.001). The overall complication rate was 3.9%. No difference in recurrence was found between techniques (p = 0.612).

Conclusion: Endoscopic discectomy yields a 6-month recurrence rate of 6.1% with clinically significant pain and functional improvement in a Pakistani provincial setting, supporting its adoption in resource-appropriate tertiary care centres.