Risk of Multiple Reoperations After Lumbar Discectomy

Österman, Heikki; Sund, Reijo; Seitsalo, Seppo; Keskimäki, Ilmo

doi:10.1097/01.brs.0000049908.15854.ed

Cited by 113 publications

(60 citation statements)

References 24 publications

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“…The results were very good in all five patients: 100% fusion rate and relief of leg pain. Several other authors describe similar findings (16,17,18,19,20,21) . In our study, the postoperative outcome was insignifcant (P=0.7826).…”

Section: Discussionsupporting

confidence: 69%

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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Section: Discussionsupporting

confidence: 69%

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

Khayat¹,

Khallaf²,

Hassan³

et al. 2017

IAM

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“…These factors include misdiagnosis, technical failure, new disc protrusion, bony compression, excessive fibrosis, facet syndrome, infection and instability 7,[22][23][24] . In a retrospective study Osterman et al 25 found a risk of 25,1% of further spinal surgery in the first ten years of follow-up. The success of spine surgery decreases after repeated surgeries 24. Gender is an uncertain prognostic factor.…”

Section: Discussionmentioning

confidence: 99%

Is preoperative occupation related to long-term pain in patients operated for lumbar disc herniation?

Almeida

Poletto

Milano

et al. 2007

Arq. Neuro-Psiquiatr.

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-Lumbar disc herniation (LDH) is a common cause of back and sciatic pain. When clinical treatment fails, surgery may be indicated in selected patients. Although surgery is effective in most cases, some of these patients may have a poor outcome. Different factors may influence these results and poor adaptation at work is one well-known cause of treatment failure. This study examines 350 patients on longterm follow-up after surgery for first-time LDH. The relationship was analyzed between occupation before surgery and outcome (maintenance of lumbar and leg pain, satisfaction with the surgical treatment and return to work). The preoperative occupation (employed in public or private services, autonomous, unemployed, housewife, retired or student) and the exertion at work were analyzed as prognostic factors for different clinical outcomes. Although unemployed people had higher numerical analog scale for lumbar pain and retired patients had a higher leg pain, this difference was not statistically significant. Retired people were significantly less satisfied with the surgical result. Higher exertion at work showed a statistically insignificant higher level of pain and lower degree of satisfaction. The authors conclude that preoperative occupation was not a statistically significant factor in this series of patients.KEY WORDS: lumbar disc herniation, occupation, failed back syndrome, outcome, discectomy.Cirurgia de hérnia de disco lombar: existe relação entre a profissão e a persistência de dor?RESUMO -A hérnia de disco lombar (HDL) é uma causa comum de dor lombar e ciática. Quando o tratamento clínico não oferece melhora dos sintomas, a cirurgia pode ser proposta em casos selecionados. Apesar de ser efetiva, uma pequena, porém significativa parcela dos pacientes operados podem não melhorar. Diversos fatores podem influenciar tais resultados. A insatisfação no ambiente de trabalho é relacionada com um maior índice de maus resultados. Neste estudo, 350 pacientes no pós-operatório tardio da primeira cirurgia de HDL foram estudados, analisando a possível relação entre tipo de profissão antes da cirurgia e evolução clínica (persistência de dor lombar e em membro inferior, satisfação com a cirurgia e retorno ao trabalho). Os pacientes foram classificados quanto à profissão em empregados públicos, empregados em órgãos privados, autônomos, desempregados, donas de casa, aposentados e estudantes. Também o grau de esforço no ambiente de trabalho foi analisado como fator prognóstico. Os desempregados relataram índices de dor lombar maiores e os aposentados tiveram maiores índices de dor irradiada, apesar de que estatisticamente os valores não foram significativos. Os aposentados ficaram significativamente menos satisfeitos com o tratamento no longo prazo. Um maior esforço no ambiente de trabalho não se correlacionou estatisticamente com o grau de dor e satisfação. Concluimos que o tipo de profissão não foi fator estatisticamente significativo na evolução destes pacientes. Os aposentados tiveram menor grau de satisfação co...

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“…The total number of cases of instability confirmed at the operated level or at both the operated and adjacent levels was 52.2% (24/46). A large retrospective follow-up study of patients undergoing multiple revisions after lumbar discectomy revealed markedly reduced risk for subsequent operations if the first procedure was a spinal fusion (5.0% vs. 24.9% after discectomy and 27.2% after spinal decompression) [10]. Therefore, the use of fusion to treat or prevent segmental instability after repeated discectomy appears to be a reasonable choice in cases of recurrent disc herniation.…”

Section: Introductionmentioning

confidence: 99%

Surgical treatment of recurrent lumbar disc herniation by transforaminal lumbar interbody fusion

Chen

Zhao

Ai-gang

et al. 2008

International Orthopaedics (SICO

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Between 2001 and 2005, 43 patients (average age 54.2, range 36-68 years) with recurrent lumbar disc herniation underwent reoperation with the transforaminal lumbar interbody fusion (TLIF) technique at our unit. All cases were followed up for 24-72 months (mean 45 months) and graded using the Japanese Orthopaedic Association (JOA) score system pre-and post-operation and during the follow-up period. The leg pain of all patients was relieved significantly within one month postoperatively. The mean JOA score was improved from 9.3 before surgery to 25.0 at the final follow-up visit (P<0.0001). The average recovery rate was 86.0% (range 52-100%). General clinical outcome was excellent in 23 (53.5%) patients, good in 14 (32.6%) and fair in 6 (13.9%). The fusion rate was 100% two years postoperatively. Three patients (7%) had transient neurological deficits, which resolved completely within 3 months. There were no major complications. We, therefore, believe the TLIF technique to be an effective procedure with satisfactory clinical results for the treatment of recurrent lumbar disc herniation.Résumé Entre 2001 et 2005, 43 patients (âge moyen 54,2 ans entre 36 à 68 ans) ont bénéficié d'une réintervention chirurgicale avec arthrodèse inter corporéale par technique transforaminale pour récidive de hernie discale lombaire. Tous ces patients ont été suivis en moyenne pendant 45 mois et évalués selon le score de la JOA en pré et post opératoire. Les douleurs des membres de tous ces patients ont été nettement améliorées dans le premier mois post opératoire. Le score de la JOA a été également améliorée de 9,3 avant l'intervention à 25 lors de la dernière revue de ces malades (P<0,0001). Le taux moyen de récupération a été de 86% (52 à 100%). L'évolution clinique générale a été excellente chez 23 patients (53,5%), bonne chez 14 patients (32,6%) et médiocre chez 6 patients (13,9%). Le taux de fusion a été de 100% en post opératoire. 3 patients (7%) ont eu des troubles neurologiques transitoires qui ont complète-ment régressé dans les trois mois. Il n'y a pas eu de complications majeures. L'étude technique TLIF est une technique efficace qui nous donne satisfaction dans le traitement des récidives de hernies discales lombaires.

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Risk of Multiple Reoperations After Lumbar Discectomy

Abstract: Patients with one reoperation after lumbar discectomy are at considerable risk of further spinal surgery.

Cited by 113 publications

References 24 publications

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

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

Is preoperative occupation related to long-term pain in patients operated for lumbar disc herniation?

Surgical treatment of recurrent lumbar disc herniation by transforaminal lumbar interbody fusion

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