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

Abstract

Background Same-level recurrent disc herniation remains a challenge in spine surgery. Although most surgeons agree on discectomy as the treatment of choice for primary lumbar disc herniation, the management of recurrent disc herniation remains ambiguous and largely depends on the operating surgeon. Many surgeons recommend repeat discectomy over fusion because it is cheaper and less invasive. In this study, we analyzed 50 patients who underwent a repeat discectomy. Materials and methods The patients in the study had previously been managed for lumbar disc herniation and then presented with either recurrent same-level herniation or symptoms attributed to the same level. The patients were then managed with a repeat discectomy without fusion. We analyzed the preoperative and postoperative Oswestry Disability Index (ODI), duration of surgery, blood loss, duration of hospitalization, and complications. Results Fifty patients were included: 27 females (54%), and 23 males (46%). They were followed up for an average of 2.81 years (range: 1-4). The mean duration of hospitalization was 4.06 ± 1.5 days (range: 2-8). The operative time was 104.60 minutes (range: 50-195), with an intraoperative blood loss of 85.40 mL (range: 50-150 mL). Durotomy occurred as a complication in eight (16%) patients. The recurrence rate was 26%, with 36% progressing to fusion. The change in preoperative ODI and postoperative ODI was 20.94 ± 7.24 (6-37), with a p-value of 0.04. There were no long-term complications recorded. Conclusion Repeat discectomy is a good management option for same-level recurrent disc herniation. The procedure is associated with low intraoperative blood loss and a short operating time, but there is a significant risk of durotomy. The risk of recurrence remains a concern due to the progression of degenerative changes, especially in the presence of Modic-2 changes. These advantages and disadvantages should be discussed with patients.

Current advancements in therapeutic approaches in orthopedic surgery: a review of recent trends

“…In postoperative care, remote patient monitoring has proven instrumental in tracking recovery progress (Khan et al, 2015;Rousset et al, 2018). The implementation of wearable devices and mobile applications, as demonstrated in the work of De Fazio et al (2023), allows continuous monitoring of critical parameters such as joint range of motion and rehabilitation exercises. Real-time data transmission enables orthopedic surgeons to assess patient progress remotely, promptly identify potential complications, and tailor rehabilitation plans accordingly (Metsemakers et al, 2018).…”

“…While the advancements in orthopedic surgery promise to improve patient outcomes, it is imperative to consider their costeffectiveness and the potential barriers to widespread adoption. A comprehensive economic evaluation, such as the one conducted by Suarez-Ahedo et al (2023), demonstrated that the initial investment in robotic-assisted surgery technologies resulted in long-term cost savings. Despite the higher upfront costs, the reduced postoperative complications, shorter hospital stays, and faster recovery times contributed to overall cost-effectiveness.…”

“…Historically, the field has been anchored in conventional surgical techniques, emphasizing precision and biomechanical principles. The advent of minimally invasive procedures in the late 20th century, as exemplified by the work of Mithany (2023), ushered in a new era, reducing surgical trauma and accelerating postoperative recovery (Mithany et al, 2023). In recent decades, technological innovations have become pivotal in defining the trajectory of orthopedic surgery.…”