Reoperation for recurrent lumbar disc herniation: a study over a 20-year period in a Japanese population

Aizawa, Tadanori; Ozawa, Hiroshi; Kusakabe, Takashi; Nakamura, Takeshi; Sekiguchi, Akira; Takahashi, Atsushi; Sasaji, Tatsuro; Tokunaga, Shigeyuki; Chiba, Takamitsu; Morozumi, Naoki; Koizumi, Yayoi; Itoi, Eiji

doi:10.1007/s00776-011-0184-6

Cited by 66 publications

(61 citation statements)

References 26 publications

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“…rLDH is the most common reason for an unsatisfactory outcome following conventional discectomy for LDH [5,7,10,11,15]. Reoperation is usually considered to be the treatment of choice for rLDH if non-operative treatment has failed.…”

Section: Discussionmentioning

confidence: 99%

“…However, lumbar discectomy has an unsatisfactory outcome in 5-20% of patients [3][4][5][6]. The most common cause of ongoing disability after discectomy is recurrent lumbar disc herniation (rLDH), which is reported to occur in 5-15% of patients, with an increasing incidence over time [3,5,[7][8][9][10]. rLDH is defined as ipsilateral or contralateral disc herniation at the same level after a pain-free interval of at least 6 months following conventional discectomy [3,7,[11][12][13][14][15].…”

Section: Introductionmentioning

confidence: 99%

“…The most common surgical procedure performed for the treatment of LDH causing back and leg pain is lumbar discectomy [1,2]. However, lumbar discectomy has an unsatisfactory outcome in 5-20% of patients [3][4][5][6]. The most common cause of ongoing disability after discectomy is recurrent lumbar disc herniation (rLDH), which is reported to occur in 5-15% of patients, with an increasing incidence over time [3,5,[7][8][9][10].…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Four-year follow-up results of transforaminal lumbar interbody fusion as revision surgery for recurrent lumbar disc herniation after conventional discectomy

Tang

Hou

Ren

et al. 2015

Journal of Clinical Neuroscience

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Four-year follow-up results of transforaminal lumbar interbody fusion as revision surgery for recurrent lumbar disc herniation after conventional discectomy

Tang

Hou

Ren

et al. 2015

Journal of Clinical Neuroscience

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“…Despite the relatively high prevalence of RLDH after lumbar discectomy, its management 17 and even its definition-whether to include both ipsilateral and contralateral reherniations 7 and the specific window of time after which a disc herniation may be considered recurrent versus a simple failure of the original surgery 1 -are the subjects of debate. The controversies are propagated by a lack of high-quality evidence comparing repeat discectomy and instrumented fusion head to head.…”

Section: Discussionmentioning

confidence: 99%

Comparing clinical outcomes of repeat discectomy versus fusion for recurrent disc herniation utilizing the N2QOD

Guan¹,

Ravindra²,

Schmidt³

et al. 2017

SPI

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OBJECTIVE Recurrent lumbar disc herniation (RLDH) is a significant cause of morbidity in patients undergoing lumbar discectomy and has been reported to occur in up to 18% of cases. While repeat discectomy is often successful in treating these patients, concern over repeat RLDH may lead surgeons to advocate instrumented fusion even in the absence of instability. The authors' goal was to compare clinical outcomes for patients undergoing repeat discectomy versus instrumented fusion for RLDH. METHODS The authors used the National Neurosurgery Quality and Outcomes Database (N2QOD) to assess outcomes of patients who underwent repeat discectomy versus instrumented fusion at a single institution from 2012 to 2015. Primary outcomes included Oswestry Disability Index (ODI) score, visual analog scale (VAS) score, and quality-adjusted life year (QALY) measures. Secondary outcomes included hospital length of stay, discharge status, and hospital charges. RESULTS The authors identified 25 repeat discectomy and 12 instrumented fusion patients with 3- and 12-month follow-up records. The groups had similar ODI and VAS scores and QALY measurements at 3 and 12 months. Patients in the instrumented fusion group had significantly longer hospitalizations (3.7 days vs 1.0 days, p < 0.001) and operative times (229.6 minutes vs 82.7 minutes, p < 0.001). They were also more likely to be female (p = 0.020) and to be discharged to inpatient rehabilitation instead of home (p = 0.036). Hospital charges for the instrumented fusion group were also significantly higher ($54,458.29 vs $11,567.05, p < 0.001). Rates of reoperation were higher in the repeat discectomy group (12% vs 0%), but the difference was not statistically significant (p = 0.211). CONCLUSIONS Repeat discectomy and instrumented fusion result in similar clinical outcomes at short-term follow-up. Patients undergoing repeat discectomy had significantly shorter operative times and length of stay, and they incurred dramatically lower hospital charges. They were also less likely to require acute rehabilitation postoperatively. Further research is needed to compare these two management strategies.

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“…( 15.0 Reoperation after lumbar spine surgery Martin et al 13) 19.0 Reoperation after lumbar spine surgery Aizawa et al 14) 3.8-24.0 Reoperation as recurred HIVD Katz et al 20) 28.0 Reoperation of decompressive surgery on spinal stenosis…”

Section: 이재철·양성석·구형모 외 1인mentioning

confidence: 99%

Causes and Timing of Reoperation after Thoraco-Lumbar Spine Surgery

Lee¹,

Yang²,

Ku³

et al. 2013

J Korean Orthop Assoc

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Purpose:We analyzed the patients who needed reoperation after undergoing a thoracolumbar spine operation and investigated the causes, pattern of timing, medical history and clinical outcome after reoperation. Materials and Methods: Out of 2,198 patients who underwent spine surgery for thoracolumbar spine disease from 1988 to 2011, we targeted 193 patients who underwent reoperation. We studied the causes, operative method of initial surgery, time-variant causes and outcome of reoperation. Results: The number of patients who underwent thoracolumbar spine reoperation was 193 out of 2,198 and the reoperation rate was 8.7%. We researched time-variant causes of reoperation. In six weeks after the initial operation, exploration for hematoma and neurologic deficit was 18 (26.8%), recurred heniated intervertebral disc (HIVD) was 18 (26.8%), and surgical site infection was 17 (25.4%). From six weeks to six months, recurred HIVD was 10 (47.6%), surgical site infection was 7 (33.3%), and after six months, adjacent segmental disease (ASD) was 38 (35.7%), recurred HIVD was 26 (23.2%), and implant related problem was 17 (16.0%). Conclusion: Causes of thoracolumbar spine reoperation included complications (2.8%); infection, hematoma, neurologic deficit, incomplete decompression, and natural courses (5.9%); ASD, recurred HIVD, implant related problem, instability after decompression, tumor recur, progression of deformity.

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Reoperation for recurrent lumbar disc herniation: a study over a 20-year period in a Japanese population

Cited by 66 publications

References 26 publications

Four-year follow-up results of transforaminal lumbar interbody fusion as revision surgery for recurrent lumbar disc herniation after conventional discectomy

Four-year follow-up results of transforaminal lumbar interbody fusion as revision surgery for recurrent lumbar disc herniation after conventional discectomy

Comparing clinical outcomes of repeat discectomy versus fusion for recurrent disc herniation utilizing the N2QOD

Causes and Timing of Reoperation after Thoraco-Lumbar Spine Surgery

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