Recurrent lumbar disc herniation: Is there a correlation with the surgical technique? A multivariate analysis

Abstract

Purpose:The recurrence of a lumbar disc herniation (LDH) is a common cause of poor outcome following lumbar discectomy. The aim of this study was to assess a potential relationship between the incidence of recurrent LDH and the surgical technique used. Furthermore, we tried to define the best surgical technique for the treatment of recurrent LDH to limit subsequent recurrences.Materials and Methods:A retrospective study was conducted on 979 consecutive patients treated for LDH. A multivariate analysis tried to identify a possible correlation between (1) the surgical technique used to treat the primary LDH and its recurrence; (2) technique used to treat the recurrence of LDH and the second recurrence; and (3) incidence of recurrence and clinical outcome. Data were analyzed with the Pearson's Chi-square test for its significance.Results:In 582 cases (59.4%), a discectomy was performed, while in 381 (40.6%), a herniectomy was undertaken. In 16 cases, a procedure marked as “other” was performed. Among all patients, 110 (11.2%) had a recurrence. Recurrent LDH was observed in 55 patients following discectomy (9.45%), in 45 following herniectomy (11.8%), and in 10 (62.5%) following other surgery. Our data showed that 90.5% of discectomies and 88.2% of the herniectomies had a good clinical outcome, whereas other surgeries presented a recurrence rate of 62.5% (Pearson's χ2< 0.001). No statistical differences were observed between discectomy or herniectomy, for the treatment of the recurrence, and the incidence for the second recurrences (P > 0.05). A significant statistical correlation emerged between the use of other techniques and the incidence for the second recurrences (P < 0.05).Conclusions:The recurrence of an LDH is one of the most feared complications following surgery. Although the standard discectomy has been considered more protective toward the recurrence compared to herniectomy, our data suggest that there is no significant correlation between the surgical technique and the risk of LDH recurrence.

Posterior longitudinal ligament suturation after lumbar discectomy provides postoperative a large intradural area: First report

“…Lumbar discectomy for the management of lumbar radiculopathy is a commonly performed procedure with generally excellent patient outcomes. [ 23 ] However, recurrent LDH remains one of the most common complications of the lumbar discectomy procedure. [ 24 ] It is not a rare event.…”

“…The occurrence of recurrence following discectomy and herniectomy has been a matter of debate. [ 23 ] Lumbar epidural fibrosis is believed to be one of the mechanisms involved in the genesis of pain. Good outcomes after surgery are an important issue,[ 26 27 ] and the reoperation rate and persistent pain after lumbar discectomy can have to change the success of the surgery.…”

Risk Factors for Recurrence of Disc Herniation After Single-Level Lumbar Discectomy

“…Standard discectomy is more helpful in reducing reherniation of the disc compared to herniectomy, to a non-statistically significant degree [20]. Subtotal or aggressive discectomy (more resection of disc material after extruded or protruded disc removal) has a lower recurrent disc herniation rate than a limited discectomy.…”

Recurrent or junctional lumbar foraminal herniated disc in patients operated withtrans pars microscopic approach

“…Similarly, at the present day, no recent studies in Literature exist speci cally dealing with junctional herniations after discectomies in general and with microscopic trans pars techniques in particular; the only existing studies are about adjacent segment pathology after lumbar arthrodesis 10,11,12 The aim of this retrospective study is therefore to speci cally analyze the rate of recurrent or junctional LDH after treating a FLHD with the microscopic trans pars approach and to show if patients' characteristics such as age, sex, level and BMI could in uence this rate.…”