Surgical Results and Risk Factors for Recurrence of Lumbar Disc Herniation

Abstract

ObjectiveRecurrent lumbar disc herniation has been defined as disc herniation at the same level, regardless of ipsilateral or contralateral herniation, with a pain-free interval greater than 6 months. The aim of this study is to analyze outcomes and identify the potential risk factors for recurrent lumbar disc herniation.MethodsThe authors retrospectively reviewed the cases of 178 patients who underwent open discectomy for single-level lumbar disc herniation. Visual analogue scales and modified Macnab criteria were used to compare the clinical outcomes between the recurrent group and the non-recurrent group.Sex, age, discectomy level, degree of disc degeneration, type of disc herniation, pain-free interval after first-operation, smoking status, and trauma were investigated as potential recurrence risk factors.ResultsOf the 178 patients for whom the authors were able to definitely assess symptomatic recurrence status, 18 patients (10.1%) underwent revision surgery for recurrent disc herniation. The most common level involved was L4-L5 (61%) and the mean period of time to recurrence was 18.7 months (6-61 months). There were 17 cases of ipsilateral herniation and 1 case of contralateral herniation. The types of herniation for which revision surgery was done were protrusion (3 cases), and transligamentous extrusion (14 cases). There were five excellent, eight good, and two fair results.ConclusionRepeated discectomy for recurrent disc herniation produced unsatisfactory outcomes. Factors such as sex, type of disc herniation and traumatic events were found to be significant risk factors.

Risk Factors of Secondary Lumbar Discectomy of a Herniated Lumbar Disc after Lumbar Discectomy

“…Various studies have reported HLD recurrence after LD, and 5% to 15% of patients undergo secondary LD [20,24]. Our study reported a 15% incidence of recurrence within a mean of 28.3 months.…”

Smoking Is an Independent Risk Factor of Reoperation Due to Recurrent Lumbar Disc Herniation

“…To our knowledge, no previous studies have reported any significant difference or trend toward difference in age between the rLDH group and the non-rLDH group. 7 , 15 , 16 Häkkinen et al reported that the age distribution of all patients in their study group was comparable to that of patients in the rLDH group. However, no mean value was described.…”

“… 2 , 7 In contrast, Jung Tae Oh found being female as a statistically significant risk factor of recurrence. 15 Shimia et al concluded that being male could predict rLDH. 8 Both studies, however, included a very small study population.…”

Biportal Endoscopic Spinal Surgery for Recurrent Lumbar Disc Herniations

“…Recurrent lumbar disc herniation (LDH) that develops at least 6 months after previous open discectomy shows a relatively frequent incidence of 7%–10%. 1 2) Surgical options for recurrent LDH could be determined based on the type of previous procedure. If the previous one was percutaneous endoscopic lumbar discectomy (PELD) through a far lateral approach, revision PELD could be performed using a posterior approach despite the high risk of dura tear associated with the use of one portal during the procedure, 3) which requires steep learning curve and special instruments for epidural scarring.…”