Discectomy for Primary and Recurrent Prolapse of Lumbar Intervertebral Discs

Ahsan, Kamrul; Najmus-Sakeb,; Hossain, Alamgir; Khan, Shahidul Islam; Awwal, M A

doi:10.1177/230949901202000102

Cited by 33 publications

(30 citation statements)

References 16 publications

(19 reference statements)

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“…These findings correlate with several studies identifying an association between younger age and reherniation [12, 18, 29]. In addition, Ahsan et al reported that patients who reherniated had higher baseline ODI scores, but this was not statistically significant in their cohort of 18 reoperations [13]. Prior studies have reported that male sex, smoking, diabetes, disc protrusion, and elevated BMI were risk factors for reherniation [9–13, 15, 30].…”

Section: Discussionsupporting

confidence: 81%

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Reoperation for Recurrent Intervertebral Disc Herniation in the Spine Patient Outcomes Research Trial

Abdu

Pearson

et al. 2017

Spine

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Study Design This study was a post-hoc subgroup analysis of prospectively collected data in the Spine Patient Outcomes Research Trial (SPORT). Objective Determine the risk factors for and to compare the outcomes of patients undergoing revision disc excision surgery in SPORT. Summary of background data Risk factors for reherniation and outcomes after revision surgery have not been well-studied. This information is critical for proper patient counseling and decision making. Methods Patients who underwent primary discectomy in the SPORT intervertebral disc herniation cohort were analyzed to determine risk factors for undergoing revision surgery. Risk factors for undergoing revision surgery for reherniation were evaluated using univariate and multivariate analysis. Primary outcome measures consisted of Oswestry Disability Index (ODI), the Sciatica Bothersomeness index (SBI), and the Short Form 36 (SF-36) at six weeks, three months, six months, and yearly to four years. Results Of 810 surgical patients patients, 74 (9.1%) received revision surgery for rehernation. Risk factors for reherniation included: younger age (HR 0.96 (0.94–0.99)), lack of a sensory deficit (HR 0.61 (0.37–0.99)) lack of motor deficit (HR 0.54 (0.32–0.91)) and higher baseline ODI score (HR 1.02 (1.01–1.03)). The time adjusted mean improvement from baseline to four years was less for the reherniation group on all outcome measures (BP 39.5 vs. 44.9, p=0.001; PF 37.1 vs. 44.5, p<0.001; ODI 33.9 vs. 38.3, p <0.001; SBI 8.7 vs. 10.5, p<0.001). At four years, only SBI (−9 vs. −11.4, p=0.002) was significantly lower in the reherniation group. Conclusions Younger patients with higher baseline disability without neurological deficit are at increased risk of undergoing revision surgery for reherniation. Those considering revision surgery for reherniation will likely improve significantly following surgery, but possibly not as much as with primary discectomy.

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Section: Discussionsupporting

confidence: 81%

“…Some studies have concluded that revision surgery outcomes were worse than for primary discectomy [2, 15–17], while other investigations showed no significant outcome difference for revision surgery compared with primary operations [12, 13, 18–21]. …”

Section: Introductionmentioning

confidence: 99%

Reoperation for Recurrent Intervertebral Disc Herniation in the Spine Patient Outcomes Research Trial

Abdu

Pearson

et al. 2017

Spine

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“…Good outcomes were demonstrated in 69% of patients. Several other authors describe similar findings (9,10,11,12,13) . Other authors have described the results of reoperative decompression and supplemental fusion for patients with recurrent lumbar disc herniation.…”

Section: Discussionsupporting

confidence: 65%

Evaluation of Treatment of Recurrent Lumbar Disc Prolapse: Fusion Versus Non Fusion

Khayat¹,

Khallaf²,

Hassan³

et al. 2017

IAM

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Background: Recurrent lumbar disc herniation is one of the most common spinal disorders. The management of recurrent lumbar disc herniation remains somewhat controversial. Surgical treatment for recurrent disc herniation can be broadly categorized as revision discectomy alone or revision discectomy and fusion. Objective: The aim of the work is the evaluation of management of recurrent lumbar disc prolapse: fusion versus non-fusion aiming to reach ideal method of treatment. Matients and Methods: This is a prospective, randomized, comparative study on 30 patients (19 M, 11 F) with recurrent lumbar disc herniation at Assiut University Hospitals from January 2015 to January 2016 (minimum 12-months follow-up) with an average age of 47.2 years (range: 30-67 years). The patients were classified into 2 groups: Group A (15 patients); who had revision discectomy alone, group B (15 patients); who had revision discectomy with fusion. The clinical and radiographic results were compared between the two groups. Clinical outcome was assessed using the Modified MacNab's Criteria and radiological outcome was assessed using Lenke classification. Results: Regarding postoperative Modified MacNab's Criteria, there is no significant difference (P=0.7826) between group A which was excellent in 7 cases (7/15, 46.7%), good in 6 cases (6/15, 40%) and fair in 2 cases (2/15, 13.3%) and group B which was excellent in 6 cases (6/15, 40%), good in 6 cases (6/15, 40%), fair in 2 cases (2/15, 13.3%) and poor in 1 case (1/15, 6.7%). In group A: 1 of 15 patients (6.7%) had dural tear while in group B: 3 of 15 patients (33.3%) have dural tear (P=0.6171) and no infection occur in group A while 2 patients (13.3%) have infection in group B. The intraoperative blood loss and length of operation were significantly less in group A. The post-surgery hospital stay was significantly different between the 2 groups, being least in group A and highest in group B. Conclusion: Surgery for recurrent lumbar disc herniation can be very successful and may approach the success rate for initial operations (80% in our study) provided proper patient selection, good and thorough examination and investigations and proper surgical technique.

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“…In this study, the mean operative time was 97±37 minutes, longer than the reported averages for primary discectomy surgeries either open (44-45min) 1,6 or MID (49min) 5 arguing that there may be less injury to the paraspinal muscles, decreased postoperative pain, and a faster recovery time. However, a recently published large randomized controlled trial (RCT, but similar to those reported for rLDH surgeries utilizing MID (90±35-98.5)…”

Section: Discussionmentioning

confidence: 53%

“…1,4 One patient developed dural tear (5.5%), with incidence close to those reported in literature for primary surgeries, as in Khan et al, 17 who reported incidence of (7.6%) in their reviewed 2,024 patients of primary discectomy, and as in Kamper et al, 16 who reported an incidence of (1.9%) from their meta-analysis pooled data, and as in Nosseir 19 who reported 2.3% (10/423) of incidental durotomy during lumbar discectomy. But lesser than those reported for rLDH surgeries in other series like by Shazli et al, 19 who reported 4 patients (26.7%) with dural tear out of 15 patients operated by MID for rLDH, and Fu et al, 18 who reported (15.6%) durotomy incidence in their 20 patient series for recurrent discectomy without posterolateral fusion.…”

Section: Discussionmentioning

confidence: 99%

Reperforming Minimally Invasive Microdiscectomy Approaches for Recurrent Lumbar Intervertebral Disc Prolapse

Hamouda¹

2017

Egyptian Spine Journal

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Background Data: Reperforming minimally invasive discectomy (MID) approaches are typically challenging and demanding for patients with recurrent lumbar disc herniation (rLDH). Purpose: The aim of this study to assess the safety and efficacy of reperforming Minimally invasive discectomy in recurrent lumbar disc herniation surgery. Study Design: Retrospective clinical case study. Patients and Methods:The author reviewed the medical records all patients reoperated after MID during the period from June 2010 to April 2016 via minimally invasive approaches for recurrent lumbar disc herniation. Age, gender, presenting symptoms, disc herniation level and side, type of MID approach used in first surgery, period between 1 st and 2 nd surgeries, redo surgery duration, intra or post-operative complications, visual analogue scale VAS for pain at 1, 30, and 90 days postoperatively were recorded. Results: We could track 18 patients (12 males, 6 females), with mean age 43.2±6.3 years. The most operated level was L4/5 in 12 patients. Disc herniation on the left side was presented in 11 patients. Mean duration between the two surgeries was 44±19 weeks. Main clinical presentations were recurrent leg pain in 16 patients and new onset of partial foot drop in 2 patients. Duration of redo surgery was 97±37 minutes. Intraoperative minor dural tears were reported in 2 with no serious sequels. VAS for leg pain improved from 7.3±1.2 preoperatively to 2.1±1.1, 1.4±0.5 and 1.2±0.4 at 1, 30 and 90 postoperative days respectively. Conclusion: MID approach for rLDH following initial MID surgery sounds feasible option with better perioperative and short-term outcome. Clinical outcome in the present study showed favourable outcome regarding operative time and incidence of dural tears with CSF leak comparing to open approaches. (2017ESJ151)

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Discectomy for Primary and Recurrent Prolapse of Lumbar Intervertebral Discs

Cited by 33 publications

References 16 publications

Reoperation for Recurrent Intervertebral Disc Herniation in the Spine Patient Outcomes Research Trial

Reoperation for Recurrent Intervertebral Disc Herniation in the Spine Patient Outcomes Research Trial

Evaluation of Treatment of Recurrent Lumbar Disc Prolapse: Fusion Versus Non Fusion

Reperforming Minimally Invasive Microdiscectomy Approaches for Recurrent Lumbar Intervertebral Disc Prolapse

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