Radiological predictors of recurrent lumbar disc herniation: a systematic review and meta-analysis

Abstract

OBJECTIVELumbar discectomy for the management of lumbar radiculopathy is a commonly performed procedure with generally excellent patient outcomes. However, recurrent lumbar disc herniation (rLDH) remains one of the most common complications of the procedure, often necessitating repeat surgery. rLDH is known to be influenced by a variety of factors, and in this systematic review the authors aimed to explore the radiological predictors of recurrence.METHODSA systematic review and meta-analysis was conducted to identify studies analyzing radiological predictors of recurrent herniation, both ipsilateral and contralateral. A search was conducted on Medline and EMBASE. Both retrospective and prospective comparative studies were included, measuring radiological parameters of lumbar discectomy patients. All factors were considered irrespective of imaging modality, and a meta-analysis of the data was performed in which 5 or more studies were identified analyzing the same parameter.RESULTSIn total, 1626 reported studies were screened, with 23 being included in this review, of which 13 were appropriate for meta-analysis. Three factors, namely disc height index, Modic changes, and sagittal range of motion, were determined to be significantly correlated with an increased rate of rLDH. Some variables were considered in only 1 or 2 different studies, and the authors have included a narrative review of these novel findings.CONCLUSIONSThe findings of associations between the radiological parameters and rLDH implicates the role of instability in the development of recurrence. Understanding the physiological factors associated with instability is important, because although early degenerative disc changes may predispose patients to herniation recurrence, more advanced degeneration likely reduces segmental motion and concurrently risk of recurrence.

Curative Effect of Foraminal Endoscopic Surgery and Efficacy of the Wearable Lumbar Spine Protection Equipment in the Treatment of Lumbar Disc Herniation

“…e treatment of lumbar disc herniation follows the principle of step-by-step treatment. Conservative treatment should be considered in the early stage [5]. If the formal treatment is ineffective or the symptoms are aggravated, minimally invasive treatment or open surgery should be considered.…”

Messung der Bandscheibenhöhen in der Lendenwirbelsäule. Vergleich von Proiektionsradiographie und Kernspintomografie, Messmethode und Bestimmung der Inter-Observer-Reliabilität

“…Knowing the radiological "normal values" of the lumbar intervertebral disc height is relevant for a number of clinical issues. On the one hand, intervertebral disc height is an important predictor for the development and prognosis of a herniated disc [23,24,25,26,27,28].…”

“…Die Kenntnis der radiologischen "Normalwerte" der lumbalen Bandscheibenhöhen ist für eine Reihe von klinischen Fragestellungen relevant. Die Bandscheibenhöhe ist einerseits ein wichtiger Prädiktor für die Entstehung und die Prognose eines Bandscheibenvorfalls [23,24,25,26,27,28].…”

Earlier or heavier spinal loading is more likely to lead to recurrent lumbar disc herniation after percutaneous endoscopic lumbar discectomy

“…Intervertebral lumbar disc degeneration is commonly accompanied by Modic changes [ 17 ], and severe intervertebral lumbar disc degeneration is significantly more common in patients with Modic changes [ 18 ]. Additionally, Modic changes are significantly correlated with an increased rate of rLDH [ 19 ]. However, our study found no difference in Modic changes between the recurrence and nonrecurrence groups.…”