Repeat discectomy for recurrent same level disc herniation: A literature review of the past 5 years

Abstract

Background: Recurrent disc herniations remain a challenge in spinal surgery. Although some authors recommend a repeat discectomy, others offer more invasive secondary fusions. Here, we reviewed the literature (2017–2022) regarding the safety/efficacy of treating recurrent disc herniations with repeated discectomy alone. Methods: Our literature search of recurrent lumbar disc herniations included; Medline, PubMed, Google scholar, and the Cochrane database. We focused on the types of discectomy performed, perioperative morbidity, costs, length of surgery, pain scores, and incidence of secondary dural tears. Results: We identified 769 cases that included 126 microdiscectomies, and 643 endoscopic discectomies. Rates of disc recurrence ranged from 1% to 25% with accompanying secondary durotomy varying from 2% to 15%. In addition, operative times were relatively short, ranging from 29.2 min to 125 min, with a relatively small average estimated blood loss (i.e., minimal to maximally 150 mls). Conclusion: Repeated discectomy was the most commonly performed treatment for same-level recurrent disc herniations. Despite minimal intraoperative blood loss and short operating times, there was a significant risk of durotomy. Notably, patients must be informed that more extensive bone removal for treating recurrent disc increases the risk for instability warranting subsequent fusion.

Repeat Discectomy for the Management of Same-Level Recurrent Disc Herniation: A Study of 50 Patients

“…Repeat surgeries usually require longer operative times due to the difficulties in tissue dissection and the risks of intraoperative complications and hemorrhage [ 25 ]. This study showed a relatively short operation time of 104.60 ± 45.44 min (50-195), similar to what is reported in the literature [ 3 , 18 , 26 ]. However, it should be noted that the duration depends on multiple factors, including the expertise of the operating surgeon, whether the surgeon performs a sequestrectomy or discectomy, whether the recurrence is on the same side as the previous surgery or on the opposite side, etc.…”

“…Any repeat operation comes with additional risks compared to first-time surgeries. The presence of adhesions and distortion of anatomy makes identification and dissection of the structures a challenge [ 3 ]. In RLDH surgery, these adhesions increase the risk of injury to the dura and spinal nerves.…”

“…However, it should be noted that the onset of degeneration is not limited to middle-aged and elderly people [ 2 ]. Symptoms of this condition include mechanical back pain, radicular pain, claudication, reduced mobility, and a decreased quality of life [ 3 ].…”