Comparing outcomes of fusion versus repeat discectomy for recurrent lumbar disc herniation: A systematic review and meta-analysis

Kerezoudis, Panagiotis; Goncalves, Sandy; Cesare, Joseph; Alvi, Mohammed Ali; Kurian, Dennis P.; Sebastian, Arjun S.; Nassr, Ahmad; Bydon, Mohamad

doi:10.1016/j.clineuro.2018.05.023

Cited by 16 publications

(8 citation statements)

References 41 publications

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“…The incidence of surgical revision in form of fusion (1.7%) is in concordance with other findings, 5,8 but inferior to the 15% found by Abdu et al 16 over an eight-year period, and to a meta-analysis finding the preferred surgical revision techniques equally discectomy (47%) and fusion (53%). 45 This inconsistency could be reflective of absent clinical guidelines and subsequent differences in surgical management as described by Dower et al 46 among others.…”

Section: Comparisons Of Groupsmentioning

confidence: 99%

The Association Between Preoperative MRI Findings and Surgical Revision Within Three Years After Surgery for Lumbar Disc Herniation

Ziegler

Carreon

Andersen

et al. 2019

Spine

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Study Design This cohort study was an analysis of prospectively collected data in the DaneSpine Database. Objective: The objective was to determine whether pre-operative magnetic resonance imaging (MRI) findings were associated with the frequency of surgical revision due to recurrent lumbar disc herniation (LDH) within three years after first-time, single-level, simple lumbar discectomy. Summary of Background Data: Because of a risk of poorer outcome in patients receiving revision surgery compared to first-time discectomy, there is a need to identify patients with LDH in risk of surgical revision prior to the primary discectomy. The association between pre-operative MRI findings and revision surgery in patients with LDH has not been thoroughly studied. Methods: Following an inter-observer reliability study pre-operative MRIs were evaluated. Potential predictive variables for surgical revision were evaluated using univariate and multivariate logistic regression analysis. Also, a sum-score of the number of MRI findings at the involved level was assessed. Results: In a study population of 451 operated patients, those who had surgical revision were significantly younger and were significantly less likely to have vertebral endplate signal changes Type 2 (OR 0.36 (95% CI 0.15-0.88)) or more than five MRI findings (OR 0.45 (95% CI 0.21-0.95)) at the involved level than the patients not undergoing surgical revision. Surgical revision was not significantly associated with any other MRI findings. Conclusions: In general, pre-operative MRI findings have a limited explanatory value in predicting surgical revision within three years after first time, single-level, simple lumbar discectomy. Both the single variable VESC Type 2 and a sum-score > 5 MRI findings at the operated level was found to be negatively associated with patients undergoing surgical revision.

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Section: Comparisons Of Groupsmentioning

confidence: 99%

The Association Between Preoperative MRI Findings and Surgical Revision Within Three Years After Surgery for Lumbar Disc Herniation

Ziegler

Carreon

Andersen

et al. 2019

Spine

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“… 7 demonstrated that 83.3% of patients experience degeneration progression following microdiscectomy. Some surgeons advocate for discectomy and fusion as the primary treatment of degenerative disc disease 18 , as signs of instability can be atypical and subject to interpretation. Furthermore, discectomy with fusion eliminates the risk of recurrence at the same-level, although the possibility of adjacent level herniation remains a concern 14 .…”

Section: Discussionmentioning

confidence: 99%

Management of recurrent lumbar disc herniation: a comparative analysis of posterior lumbar interbody fusion and repeat discectomy

Musa,

Makirov,

Chmutin

et al. 2024

Annals of Medicine &Amp; Surgery

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Background: For Recurrent lumbar disc herniation, many experts suggest a repeat discectomy without stabilization due to its minimal tissue manipulation, lower blood loss, shorter hospital stay, and lower cost, recent research on the role of instability in disc herniation has made fusion techniques popular among spinal surgeons. We compare the postoperative outcomes of posterior lumbar interbody fusion (PLIF) and repeat discectomy for same-level recurrent disc herniation. Methods: The patients included had previously undergone discectomy and presented with a same-level recurrent lumbar disc herniation. The patients were placed into two groups: 1) discectomy only, 2) posterior lumbar interbody fusion based on the absence or presence of segmental instability. Preoperative and postoperative Oswestry disability index scores, duration of surgery, blood loss, duration of hospitalization, and complications were analyzed. Results: The repeat discectomy and fusion groups had 40 and 34 patients respectively. The patients were followed up for 2.68 (1-4) years. There was no difference in the duration of hospitalization (3.73 vs. 3.29 d P 0.581) and operative time (101.25 vs. 108.82mins, P 0.48). Repeat discectomy had lower intraoperative blood loss, 88.75 mL (50–150) versus 111.47 mL (30-250) in PLIF (P 0.289). PLIF had better ODI pain score 4.21(0-10) versus 9.27(0-20) (P value of 0.018). Recurrence was 22.5% in repeat discectomy versus 0 in PLIF. Conclusion: PLIF and repeat discectomy for recurrent lumbar disc herniation have comparable intraoperative blood loss, duration of surgery and hospital stay. PLIF is associated with lower durotomy rates and better long-term pain control than discectomy. This is due to recurrence and progression of degenerative process in discectomy patients which are eliminated and slowed respectively by PLIF.

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“…In DIVD patients, we need to assess the inflammation process in terms of pain that radiates to the extremities and beck (17). CRP, which is accepted as a better indicator of inflammation than erythrocyte sedimentation rate ( 18), responds more quickly to changes in a more sensitive clinical situation than many parameters (18).…”

Section: Discussionmentioning

confidence: 99%

Diagnostic Efficiency of Inflammatory Prognostic Index on Pain Scoring for Degenerated Intervertebral Disc

Firidin

Akyüz

2022

Medical Records

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Introduction: Inflammatory Prognostic Index (IPI), calculated via Albumin, CRP, and Neutrophil-Lymphocyte Ratio (NLR), is used in inflammation-related diseases. The study focused on the efficacy and predictive effect of the IPI in terms of Visual Analog Scales (VAS) for interpretation of back and leg pain. Materials and Methods: This multicenter retrospective clinical study was performed by the hospital records of the DIVD patients treated between January 2020 and February 2022. IPI value was calculated by the formula of “CRPxNLR/Albumin”. Results: There was a significant difference between VAS-B (2.38±1.74; p=0.0001) and VAS-L (7.09±1.44; p=0.00017) in the comparison of paired VAS values before and after the surgery. A similar change occurred within walking distance after surgery. According to the correlation analysis of the IPI index with DIVD pain scoring, VAS-B(r=0,391; p=0,00017) and delta VAS-B (r=0,422; p=0,00004) showed a positive correlation with the IPI. In the ROC analysis for the diagnostic value of the IPI, the cut-off value of VAS-L above 0.184 showed a diagnostic value as 78.9% sensitivity and 64.3% specificity [UAC:0.702; p:0.003; CI%95: 0.581-0.815). Conclusion: We showed a strong relationship between IPI and pain scoring of DIVD. The diagnostic value of IPI with VAS-L was very important and can be used by physicians for pain follow-up of DIVD.

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Comparing outcomes of fusion versus repeat discectomy for recurrent lumbar disc herniation: A systematic review and meta-analysis

Cited by 16 publications

References 41 publications

The Association Between Preoperative MRI Findings and Surgical Revision Within Three Years After Surgery for Lumbar Disc Herniation

The Association Between Preoperative MRI Findings and Surgical Revision Within Three Years After Surgery for Lumbar Disc Herniation

Management of recurrent lumbar disc herniation: a comparative analysis of posterior lumbar interbody fusion and repeat discectomy

Diagnostic Efficiency of Inflammatory Prognostic Index on Pain Scoring for Degenerated Intervertebral Disc

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