Recurrent lumbar disc herniation: A prospective comparative study of three surgical management procedures

Abstract

Context:The optimal surgical treatment of recurrent lumbar disc herniation is controversial.Aim:To compare prospectively the clinical outcomes of surgical treatment of recurrent lumbar disc herniation by three different methods; discectomy alone, discectomy with transforaminal lumbar interbody fusion (TLIF), and diecectomy with posterolateral fusion (PLF), regardless of the postoperative radiological findings.Study Design:This is a prospective, randomized, comparative study.Materials and Methods:This is a prospective, randomized, comparative study on 45 patients with first time recurrent lumbar disc herniation. Patients were evaluated clinically by using the criteria of the Japanese Orthopedic Association's evaluation system for low back pain syndrome (JOA score). The patients were classified into three groups: Group A; patients who had revision discectomy alone, group B; patients who had revision discectomy with TLIF, and group C; patients who had revision discectomy with PLF. The mean follow-up period was 37 (±7.85 STD) months.Results:The mean overall recovery rate was 87.2% (±19.26 STD) and the satisfactory rate was 88.9%. Comparison between the three groups showed no significant difference with regard to the mean total postoperative JOA score, recovery rate, and satisfactory rate. However, the postoperative low back pain was significantly higher in group A than that of group B and C. Two patients in group A required further revision surgery. The incidences of dural tear and postoperative neurological deficit were higher in group A. The intraoperative blood loss and length of operation were significantly less in group A. The total cost of the procedure was significantly different between the three groups, being least in group A and highest in group B. There was no significant difference between the three groups with regard to the length of postoperative hospital stay.Conclusion:Revision discectomy is effective in patients with recurrent lumbar disc herniation. Fusion with revision discectomy improves the postoperative low back pain, decreases the intraoperative risk of dural tear or neural damage and decreases the postoperative incidence of mechanical instability or re-recurrence. TLIF and PLF have comparable results when used with revision discectomy, but PLF has significantly less total cost than TLIF.

Minimally invasive tubular microdiscectomy for recurrent lumbar disc herniation

“…This incidence is in the midrange of values (13%-27%) reported in the literature concerning revision microdiscectomy via open or tubular approach. 6,18,43,48 Our reported incidence is clearly higher than in the ETD (nil) 1,14,39 and slightly higher than in MED (7.4%-12.5%). 15,24,32,43 Compared with a series of patients that were treated with open revision microdiscectomy in our clinic (data not shown), the durotomy incidence rate is not significantly higher.…”

The relation of matrix metalloproteinase 1, 2, 3 expressions with clinical and radiological findings in primary and recurrent lumbar disc hernias

“…Etiopathogenesis is attributed to ceasing of annulus during operation, insufficient nucleation of nucleus pulposus, or displacement of a free fragment. Recurrence of lumbar disc herniation was reported as between 3% and 18% (9,10,11). In the present study, 37 (46.3%) of the cases were presented with recurrent LDH.…”

Lumbar spine fusion: what is the evidence?

“…One review, rated at critically low quality, addressed the role of fusion for recurrent disc herniation . They concluded that there was no clinical advantage to the addition of fusion to repeat decompression for recurrent disc herniation; however, only one RCT ( n = 45) was used in this review.…”

“…Complications from spinal fusion surgery for low back pain are common. One moderate-quality review 4 estimated the rate of early surgical complications to be 16% (95% CI [12][13][14][15][16][17][18][19][20]. A more recent low-quality review 13 estimated that complications such as infections, thrombosis, nerve root injury by pedicle screw and major bleeding are much greater with surgery (relative risk (RR) 22.11 (95% CI 5.99-81.60).…”