A Prospective Cohort Study of Close Interval Computed Tomography and Magnetic Resonance Imaging After Primary Lumbar Discectomy

Abstract

Larger anular defects and less disc removal increased the risk of reherniation. Greater volumes of disc removal were associated with accelerated disc height loss. In the setting of larger anular defects or less aggressive disc removal, concern for recurrent herniation should be increased during outpatient follow-up. In this situation effective anular repair may be helpful.

Recurrent disc herniation: Etiology, evaluation, treatment, outcomes, and prevention (annular repair)

“…In 2009, McGirt et al 35 sought to investigate factors that could possibly lead to recurrent disc herniation. Using intraoperative measurements of volume of disc removed, estimated area of annular defect and post-operative CT and MRI, researchers quantified that patients with "greater mean annular defect area (46718 vs. 32714 mm 2 , P o 0.05) and a lower percentage of their disc volume removed (13% vs. 28%, P o 0.08)" had higher likelihood of symptomatic recurrence.…”

“…35,36 Investigations into the potential benefit of annular repair at the time of discectomy are also an active area of research. Grunert et al 42 utilized high-density collagen (HDC) gel in rat intervertebral disc after creating an iatrogenic needle puncture defect.…”

Lumbar Discectomy Review

“…Higher risks of recurrent disc herniation were seen in patients with large posterior annular defects and non-contained extruded disc fragments. 72,74 Patients that had larger volumes of disc removed had increased rates of disc height loss, the clinical relevance of which remains unclear. 74 Other post-operative complications of lumbar microdiscectomy include radiculitis/nerve root injury (<1%), thromboembolic disease (<1%), wound hematoma (1%), and wound infection (3%).…”

“…72,74 Patients that had larger volumes of disc removed had increased rates of disc height loss, the clinical relevance of which remains unclear. 74 Other post-operative complications of lumbar microdiscectomy include radiculitis/nerve root injury (<1%), thromboembolic disease (<1%), wound hematoma (1%), and wound infection (3%). 5 Other reported complications following microdiscectomy, include acute cauda equina syndrome occurring in 0.2%-1% of the surgeries for lumbar disc herniation.…”

The High Prevalence of Symptomatic Degenerative Lumbar Osteoarthritis in Chinese Adults

“…Conventional lumbar osteoarthritis treatment is conservative or surgical. Surgical treatment includes a high recurrence rate of lumbar disc herniation (range, 9% to 10.2%) 7,8. The prevalence of lumbar osteoarthritis differs by country.…”