Preoperative Risk Factors for Recurrent Lumbar Disk Herniation in L5–S1

Kim, Kyoung-Tae; Lee, Dong-Hyun; Cho, Dae-Chul; Sung, Joo-Kyung; Kim, Young-Baeg

doi:10.1097/bsd.0000000000000041

Cited by 78 publications

(97 citation statements)

References 18 publications

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“…Kim et al 13,14 found significant association between an increased disc height index and sagittal range of motion at the operated level, to a higher rate of recurrence. Clearly, causes for a recurrent disc can be multifactorial.…”

Section: Risk Factorsmentioning

confidence: 97%

Recurrent disc herniation: Etiology, evaluation, treatment, outcomes, and prevention (annular repair)

Khalsa

Amorosa

2016

Seminars in Spine Surgery

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Section: Risk Factorsmentioning

confidence: 97%

Recurrent disc herniation: Etiology, evaluation, treatment, outcomes, and prevention (annular repair)

Khalsa

Amorosa

2016

Seminars in Spine Surgery

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“…In 2006, Carragee et al reported an 18% re-herniation rate after limited discectomy, compared to 9% after aggressive procedures [18]. Some studies also reported a much higher incidence of symptomatic recurrent LDH to about 18%-27.3% in patients with large annular defects (> 6 mm) [19][20][21]. Thus, attempts to reduce the recurrent herniation have been tried again and again, and annular repair may be an answer.…”

Section: Discussionmentioning

confidence: 99%

Is annular repair technique useful for reducing reherniation and reoperation after limited discectomy

Zhang¹,

Tang²,

Jiang³

et al. 2020

Preprint

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BackgroundThe annular defect because of the primary lumbar disc herniation (LDH) or surgical procedure is considered as a main reason for recurrent herniation and eventually reoperation. Efforts to close the defect with annular repair devices have been attempted several times but the results were controversial. The present aims to detect whether the annular repair techniques were useful for reducing the re-herniation and re-operation rate after limited discectomy for LDH patients.MethodsThe Pubmed, Cochrane library, and Embase databases were searched to retrieve relevant studies published before January 1, 2020. Continuous variables were compared by calculating the standard difference of the means (SDM), whereas categorical dichotomous variables were assessed using relative risks (RRs). A random-effects model was used if the heterogeneity statistic was significant; otherwise, a fixed-effects model was used. ResultsA total of 10 researches were suitable for the meta-analysis, including four different repair techniques and a total of 1907 participates (1203 treated and 704 control). In comparison with the control group, there was no statistical difference with the ODI, VAS-leg, and VAS-back scales for patients treated with annular repair. However, the use of an annular repair device was associated with a significant reduction in the re-herniation (p=0.004) and re-operation (0.004) rates. There was no difference between the groups with the perioperative complications, but much more device related long term complications happened in the annual repair group (p=0.031) though it still decreased the overall re-operation rate significantly (p=0.006).ConclusionOur results demonstrated that the use of an annular repair device was safe and useful for reducing re-herniation and re-operation rates.

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“…Many factors are affecting the recurrence of LDH, such as postoperative defect of the annulus fibrosus, the degree of disc degeneration, obesity, smoking, and other factors. 4,7,[21][22][23][24][25] Lebow et al found that recurrence after nucleus pulposus removal occurred mostly in the original nucleus. 26 Rupture of AF around with high level of phospholipase A 2 , which aggravates the hyperplasia of scar tissue.…”

Section: Discussionmentioning

confidence: 99%

Discectomy Combined with Annulus Fibrosus Repair for the Treatment of Lumbar Disc Herniation: A Bayesian analysis of Random Controlled Trials

Bai

Shi

et al. 2020

Preprint

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Objective To investigate clinical effects of discectomy combined with annulus fibrosus (AF) repair for the treatment of lumbar disc herniation. Methods We searched PubMed, Embase, Web of Science, CNKI and WanFang data for studies evaluating discectomy combined with AF repair and discectomy for the treatment lumbar disc herniation. Two reviewers selected studies, assessed quality, and extracted data. This meta-analysis was performed to calculate the weighted mean difference (WMD), risk ratios (RRs), and 95% confidence intervals (CIs). Results Six randomized controlled trials (RCTs) were included in the meta-analysis. The pooled results suggested that the recurrence rate and reoperation rate in the non-repair group versus those in the repair group [RR= 2.64, 95% confidence interval (CI) 1.09, 6.41], [RR=1.33, CI 0.85, 2.10], respectively. The rate of Visual analogue scale (VAS) relief in the repair group was significantly better than in non-repair group [WMD=0.23, CI 0.04, 0.42], and did not increase the incidence of postoperative complications. There were no significant differences between the two surgical procedures in the Oswestry disability index (ODI) reduction [WMD=-0.18, CI -1.50, 1.14], intraoperative blood loss [WMD = -1.23, CI -4.46, 2.00] and the length of the surgical incision [WMD = 0.08, CI -0.01, 0.18]. However, the operation time of the repair group was slightly longer than non-repair group [WMD =6.73, CI 2.80, 10.66]. Conclusion Discectomy combined with AF repair is superior to discectomy regarding postoperative recurrence rate and postoperative pain relief, but the operation time is slightly longer than the latter. There is no significant difference in reoperation rate, intraoperative blood loss, length of the surgical incision, postoperative complication rate, and reduction in ODI between the two surgical procedures.

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Preoperative Risk Factors for Recurrent Lumbar Disk Herniation in L5–S1

Abstract: Moderate disk degeneration, a large sROM, a small RT, and a low IHI are biomechanical risk factors of rLDH in L5-S1. The results also suggested being male and having a large annular defect increase recurrence after discectomy, especially in cases of ipsilateral rLDH.

Cited by 78 publications

References 18 publications

Recurrent disc herniation: Etiology, evaluation, treatment, outcomes, and prevention (annular repair)

Recurrent disc herniation: Etiology, evaluation, treatment, outcomes, and prevention (annular repair)

Is annular repair technique useful for reducing reherniation and reoperation after limited discectomy

Discectomy Combined with Annulus Fibrosus Repair for the Treatment of Lumbar Disc Herniation: A Bayesian analysis of Random Controlled Trials

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