Reoperation After Herniated Disc Removal in Patients With Lumbar Degenerative Disc Disease

Abstract

Objective. To analyze the reasons for and to evaluate the results of repeated surgery in patients with lumbar degenerative disc disease after the removal of herniated discs. Material and Methods. The results of surgical treatment in 186 patients (mean age 48.7 years) treated between 2013 and 2014 at the Federal Center for Neurosurgery in Novosibirsk were analyzed. All patients previously underwent surgery for lumbar disc herniation in different hospitals. Primary intervention at one level was performed in 171 patients (92.0 %), and at two levels-in 15 patients (8.0 %). Results. Progression of degeneration at the operated segment was detected in 155 patients (83.3 %). Out of them, recurrent disk herniation was diagnosed in 92 patients (49.5 %) and instability at the operated level was found in 63 patients (33.8 %). Adjacent segment degeneration was diagnosed in 31 patients (16.7 %). After surgery, positive results in pain regression were achieved in 87.1 % of cases, and unsatisfactory results with preserved pain intensity were observed in 12.9 %. Conclusion: The main causes of reoperation after primary microdiscectomy were recurrent disc herniation and instability of the operated segment. In 16.7 % of cases, repeated surgery was performed for the adjacent segment degeneration, which must be regarded as a sequela of primary disease. The use of differential surgical treatment strategy based on the identification of the dominant clinical and neurological syndrome provides good and satisfactory results in patients undergoing reoperation after primary microdiscectomy.

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

“…Loparev et al . 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.…”

“…Additionally, many patients who undergo repeat discectomies may eventually require fusion within 4 years 22 . Discectomy alone is not enough to address the instability associated with disc herniation and can lead to deformity and overt instability 7 . Our study also found that 22.5% of patients required fusion within the 4-year follow-up period and 88.9% had MRI features of Modic-2 changes.…”

“…Nonetheless, numerous studies have indicated that there is no discernible difference in pain outcomes between a repeat discectomy and fusion for disc herniation 4 , 14 , 28 . After degenerative disease, postoperative pain arises due to various factors like disc degeneration, intervertebral instability, osteoporosis, facets degeneration, paraspinal muscle degeneration, and endplate damage 7 , 31 . Though discectomy and fusion demonstrate similar satisfaction rates in the early follow-up period, discectomy patients tend to have lower satisfaction rates in the long run due to recurring back pain 4 , 12 , 28 .…”

“…Consequently, postoperative pain persists and may eventually require fusion procedures with the progression of degeneration 1 , 31 . On the other hand, fusion deals with lumbar motion segment instability, disc, and facet factors but does not adequately address muscle degeneration and osteoporosis, which can lead to persistent pain with both fusion and nonfusion management 7 . Our study yielded lower postoperative ODI and patient satisfaction rates in the fusion group compared to the repeat discectomy group.…”

“…Disc herniation is a common manifestation of degenerative spine disease and is typically managed through various discectomy techniques, such as open surgery, microdiscectomy, and endoscopic discectomy 3 – 5 . However, the recurrence rate following discectomy can be as high as 30%, and instability progression rates are around 25% 6 , 7 . Risk factors for recurrence include smoking, young age, being overweight, and increased disc height 8 , 9 .…”