Revision surgery for lumbar disc herniation

Abstract

We reviewed 45 patients who had undergone repeated open operations for lumbar disc herniation. There were 26 men and 19 women with a mean follow up of 4.3 years. Twenty-fourpatients had had one previous discectomy, 12 had 2, and 9 had 3 or more; 11 needed a fusion without instrumentation. Residual or re-extruded disc hernias, either sub-or transligamentous, were frequently found at revision. Good to excellent results were obtained in 64%. Those who had a first-time revision had earlier improvement and better results. Complete removal and a thorough search for herniated disc material is essential when carrying out the initial operation for extruded or sequestrated herniation. At revision, removal of as much as possible of the remaining nucleus and annulus, but with minimal invasion of the posterior elements, is crucial for improving the outcome. R~sumfi. Notre dtude porte sur 45 patients ayant subi ~t plusieurs reprises une discectomie lombaire. Ce groupe itait composd de 26 hommes et de 19 femmes suivis pendant 4,3 ansen moyenne (de 1 gt 8 ans). Vingt-quatre patients avaient ddjit dt~ operas une fois, 12 deux fois et 9 trois fois ou plus. Une arthrodbse dtait indiqu~e dans 11 cas. Les rdinterventions ont montri que des hernies rdsiduelles ou ri-expulsdes, sous-ligamentaires ou trans-ligamentaires, dtaient souvent retrouvdes. 64% (29/45) des patients ont eu de bons ou d'excellents rdsultats. Les patients n 'ayant subi qu' une seule rdintervention se sont rdtablis plus rapidement et ont prdsent~ de meilleurs r~sultats. Nous tenons ~ souligner qu 'iI est essentiel de procider gz Reprint requests to: H. Baba l'ablation complkte et ~ la recherche mdticuleuse de tousles mat~riaux discaux hernids lors de la premikre intervention, en particulier pour les hernies expuls~es ou siquestrYes. En cas de r~in-tervention il convient d'enlever autant d'anneau et de noyau rdsiduel que possible, quoique plus moddrdment en arrikre, pour obtenir les meilleurs rdsultats.

Clinical outcomes after minimal-access surgery for recurrent lumbar disc herniation

“…4,10,13,19 Microendoscopic discectomy approaches for primary lumbar disc herniation have also yielded comparable success rates, although long-term outcome data are still forthcoming. 1,15 In terms of reoperation for recurrent lumbar disc herniations, open discectomy has resulted in acceptable relief of radicular pain and overall success rates comparable with the primary surgery. 3,7,8,17,18 In general, factors favoring a successful outcome after reoperation for recurrent lumbar disc herniation have included a pain-free interval longer than 6 months after the initial surgery, revision incorporating a fusion, and a definitive finding of a recurrent disc at surgery.…”

“…Additionally, cases of failed-back syndrome requiring revision discectomy and fusion can also be treated using minimal-access techniques. In a study of 45 patients treated for single or multiple recurrent disc herniation, of which 24% required concurrent fusion, Baba, et al, 1 concluded that minimal destruction of the posterior elements was crucial for improving outcomes in revision lumbar surgery. Minimal-access techniques are ideally suited for reducing destruction of posterior elements, which includes muscle, ligaments, and bone.…”

Recurrent lumbar disc herniation: A prospective comparative study of three surgical management procedures

“…[13] Although early reports documented less satisfactory outcomes with revision discectomy,[1314] more investigations which controlled for confounding factors such as foraminal stenosis and adjacent level herniations showed that results are more comparable with those for primary disc surgery. [12378910] Cinotti et al .…”

Failed Back Surgery Syndrome in Lomber Disc Herniation: The Retrospectıve Analysis of Success Scorings of Epidural Fibrosis and Recurrent Cases in Reoperations

“…However Baba and his friends Express that anulus and nucleus have to been removed as much as possible (20). It is also stated that radical discectomy decreases disc function and lead patients experience postoperative back pain more (19).…”