SpineRecurrent lumbar disc herniation after discectomy: outcome of repeat discectomy
Introduction
The operative technique in the treatment of lumbar disc herniation has been perfected, so success can be expected in most patients undergoing disc surgery. However, the results after discectomy are sometimes unsatisfactory and back and/or sciatic pain may be recurrent or increased. Standard open discectomy is associated with a 10% to 15% failure rate [15], [17], [28], [30]. The causes of failure are insufficient neural decompression, surgery at the wrong level, traumatization of the nerve root, persistent lateral and/or central spinal stenosis, and segmental instability. Wrong surgical indication, wrong preoperative diagnosis, and wrong surgical planning will also lead to the failure of surgery. When sciatic pain is recurrent after a pain-free interval following discectomy, recurrent disc herniation should be one of the diagnoses first considered. It has been reported that the reoperation risk after discectomy is more frequent than previously assumed [21]. Failed back surgery syndrome has been frequently reported [1], [3], [11], [13], [14], [17], [21], [22], [27], [33], but recurrent disc herniation after discectomy is relatively lacking in specific studies and is usually reviewed along with other causes of failed disc surgery.
In this study, a group of patients with recurrent disc herniation undergoing repeat discectomy was retrospectively analyzed. The purpose of the current study was to address the outcome in these patients treated with repeat discectomy and to identify the factors that may influence the outcome.
Section snippets
Patients and methods
Between 1985 and 2000, 39 consecutive patients were treated for recurrent lumbar disc herniation at our hospital. The medical records and available imaging studies were reviewed. There were 23 men and 16 women in the study. The average age of the patients at the surgery was 48 years (range, 27-72 years).
Recurrent disc herniation was defined as disc herniation at the same level as the primary herniation, either on the same or the opposite side. The pain-free interval after primary discectomy
Results
The disc pathology noted during the revision surgery was of the contained type in 7 patients and the noncontained type in 32 patients. There were 2 extreme lateral disc herniations, including 1 ipsilateral and 1 contralateral herniation, compared with the prior posterolateral disc herniation. Epidural fibrosis was seen in 25 patients.
There were 7 dural tears during the revision surgery. The dural tears were directly repaired using sutures in 3 of the 7 patients. No cerebrospinal fluid leakage
Discussion
The definition of recurrent disc herniation has varied among the different authors. A recurrent disc herniation was sometimes defined as the disc herniation developing in the same level as the prior discectomy [4], [5], [14], [26], [31], either on the same or the opposite side, whereas more authors included the herniation at a new level in their study series [2], [6], [10], [11], [12], [15], [16]. In our opinion, the latter situation should be considered as a new herniation.
Recurrent disc
References (33)
- et al.
Revision surgery for lumbar disc herniation: an analysis of 45 patients
Int Orthop
(1995) - et al.
The treatment of lumbar disc herniation: simple fragment excision versus disc space curettage
J Spinal Disord
(1991) - et al.
Repeat surgery after disc excision
Spine
(1978) - et al.
Contralateral recurrent lumbar disc herniation: results of discectomy compared with those in primary herniation
Spine
(1999) - et al.
Ipsilateral recurrent lumbar disc herniation: a prospective, controlled study
J Bone Joint Surg Br
(1998) Surgery for recurrent lumbar disc herniation
Clin Neurosurg
(1991)- et al.
Lumbar disc herniation in the patients with developmental spinal stenosis
Eur Spine J
(1996) - et al.
Effect of discectomy on the stress distribution in lumbar spine
Chin Med J (Engl)
(1992) - et al.
The effect of flexion-extension motion of the lumbar spine on the capacity of spinal canal: an experimental study
Spine
(1989) A long-term outcome analysis of 984 surgically treated herniated lumbar discs
J Neurosurg
(1994)
Microsurgical reoperation following lumbar disc surgery: timing, surgical findings, and outcome in 92 patients
J Neurosurg
Recurrent herniation of the lumbar intervertebral disc
Clin Orthop
Results of surgical intervention in the symptomatic multiply-operated back patient: analysis of sixty-seven cases followed three to seven years
J Bone Joint Surg Am
Reoperation after lumbar disc surgery: results in 130 cases
Acta Neurochir (Wien)
A lumbar disc surgery predictive scoreboard
Spine
Recurrent lumbar disc herniation: results of repeat laminectomy and discectomy
J Spinal Disord
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