Elsevier

Surgical Neurology

Volume 64, Issue 3, September 2005, Pages 226-231
Surgical Neurology

Spine
Recurrent lumbar disc herniation after discectomy: outcome of repeat discectomy

https://doi.org/10.1016/j.surneu.2004.11.003Get rights and content

Abstract

Background

Recurrent disc herniation after discectomy is relatively lacking in specific studies and is usually reviewed along with other causes of failed disc surgery. The purpose of the current study was to address the outcome in the patients who had recurrent disc herniation treated with repeat discectomy and to identify the factors that may influence the outcome.

Methods

Thirty-nine patients who underwent repeat discectomy for recurrent lumbar disc herniation were retrospectively analyzed. Of these patients, 27 had recurrent disc herniation at the L4 to L5 level, 11 at the L5 to S1, and 1 at the L3 to L4. They almost had the typical presentation of sciatica. The time from prior discectomy to that of recurrence ranged 6 months to 17 years (average, 5 years and 4 months). The Japanese Orthopaedic Association (JOA) score averaged 12 (range, −3 to 18). All patients had a follow-up evaluation at 1 and 15 years (average, 7 years and 8 months) after surgery.

Results

Their JOA score increased to 12 to 29 (average, 24), with the recovery rate of 29% to 100% (average, 72%). Twenty-nine patients returned to their previous work status or normal daily activity, 7 had significant improvement, and 3 needed analgesic drugs although they had pain relief to different degrees.

Conclusions

The outcomes of repeat discectomy for recurrent disc herniation were satisfactory. No factors such as age, sex, traumatic events, times of prior surgery, level of herniation, side of recurrence, pain-free interval, duration of recurrence symptoms, walking capacity, the preoperative JOA score, associated spinal stenosis, procedures of revision surgery, and dural tear were found to be of predictive value for a prognosis of revision surgery for recurrent disc herniation (P > .05).

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)

  • H. Baba et al.

    Revision surgery for lumbar disc herniation: an analysis of 45 patients

    Int Orthop

    (1995)
  • R.A. Balderston et al.

    The treatment of lumbar disc herniation: simple fragment excision versus disc space curettage

    J Spinal Disord

    (1991)
  • J. Cauchoix et al.

    Repeat surgery after disc excision

    Spine

    (1978)
  • G. Cinotti et al.

    Contralateral recurrent lumbar disc herniation: results of discectomy compared with those in primary herniation

    Spine

    (1999)
  • G. Cinotti et al.

    Ipsilateral recurrent lumbar disc herniation: a prospective, controlled study

    J Bone Joint Surg Br

    (1998)
  • E.S. Connolly

    Surgery for recurrent lumbar disc herniation

    Clin Neurosurg

    (1991)
  • L. Dai et al.

    Lumbar disc herniation in the patients with developmental spinal stenosis

    Eur Spine J

    (1996)
  • L.Y. Dai et al.

    Effect of discectomy on the stress distribution in lumbar spine

    Chin Med J (Engl)

    (1992)
  • L.Y. Dai et al.

    The effect of flexion-extension motion of the lumbar spine on the capacity of spinal canal: an experimental study

    Spine

    (1989)
  • R.A. Davis

    A long-term outcome analysis of 984 surgically treated herniated lumbar discs

    J Neurosurg

    (1994)
  • U. Ebeling et al.

    Microsurgical reoperation following lumbar disc surgery: timing, surgical findings, and outcome in 92 patients

    J Neurosurg

    (1989)
  • J.A. Epstein et al.

    Recurrent herniation of the lumbar intervertebral disc

    Clin Orthop

    (1967)
  • W.J. Finnegan et al.

    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

    (1979)
  • J. Fandino et al.

    Reoperation after lumbar disc surgery: results in 130 cases

    Acta Neurochir (Wien)

    (1993)
  • B.E. Finnenson

    A lumbar disc surgery predictive scoreboard

    Spine

    (1978)
  • L. Herron

    Recurrent lumbar disc herniation: results of repeat laminectomy and discectomy

    J Spinal Disord

    (1994)
  • Cited by (66)

    View all citing articles on Scopus
    View full text