Risk Factors and Surgical Treatment for Recurrent Lumbar Disc Prolapse: A Review of the Literature

Abstract

We aim to present the current evidence on various risk factors and surgical treatment modalities for recurrent lumbar disc herniation (rLDH). Using PubMed, a literature search was performed using the Mesh terms "recurrent disc prolapse," "herniated lumbar disc," "risk factors," and "treatment." Articles that were published between January 2010 and May 2017 were selected for further screening. A search conducted through PubMed identified 213 articles that met the initial screening criteria. Detailed analyses showed that 34 articles were eligible for inclusion in this review. Sixteen articles reported the risk factors associated with rLDH. Decompression alone as a treatment option was studied in seven articles, while 11 articles focused on different types of fusion surgery (anterior lumbar interbody fusion, posterior lumbar interbody fusion, open transforaminal lumbar interbody fusion [TLIF], and minimally invasive surgery-TLIF). Management of the rLDH requires consideration of the possible risk factors present in individual patients before primary and at the time of second surgery. Both, minimally invasive and conventional open procedures are comparably effective in relieving leg pain, and minimally invasive techniques offer advantage over the other technique in terms of tissue sparing. Non-fusion surgeries involve the risk of lumbar disc herniation re-recurrence, and the patient may require a third (fusion) surgery.

Unilateral dynamic stabilization in recurrent lumbar disc herniation

“…Revision discectomy is the most common surgical procedure in RLDH patients with persistent pain and loss of motor and/ or sensory function that does not benefit from conservative treatment. If the patient has additional preoperative or perioperative instability, lumbar stabilization is performed with revision discectomy (2,7). Revision of spinal surgery is very difficult due to changes in perineural granulation tissue and anatomical structures (9).…”

“…discectomy surgery. Lumbar discectomy reportedly has a recurrence rate of 5%-25% (3,7,29). Surgical intervention is indicated in patients with persistent pain and loss of motor and/or sensory function that do not benefit from conservative treatment.…”

“…Additionally, iatrogenic instability may develop during surgery. Some studies suggest that only revision discectomy is the preferred approach in RLDH (14,19), whereas others suggest that stabilization eliminates the need for subsequent surgical intervention (5,7,9,24).…”

Fusion versus nonfusion treatment for recurrent lumbar disc herniation

“…[ 6 ] The incidence of RLDH is reported in the range of 0.5%–25% of patients. [ 7 8 ] Options of surgical treatment of a symptomatic RLDH include simple conventional revision discectomy or discectomy with instrumented fusion. Controversy still exists on which is the better treatment option or when fusion would be advantageous over simple revision discectomy for a recurrent symptomatic lumbar disc herniation.…”

Transpedicular Screw Fixation for Microinstability in Recurrent Lumbar Disc

“…2 Recurrent lumbar disc herniation (RLDH) is a major etiology of surgical failure, with an incidence of 5 to 23%, that increased with extended follow up period. 3,4,5 The surgical choices for recurrent herniation are usually limited. This limitation ascribed to many factors, for example the duration of operative time (it usually needs a longer time).…”