The Role of Fusion for Recurrent Disk Herniations

Greenleaf, Robert; Harris, Mitchel B.; Bono, Christopher M.

doi:10.1053/j.semss.2011.05.010

Cited by 21 publications

(18 citation statements)

References 50 publications

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“…Various techniques have been used for the surgical treatment of rLDH, including posterior lumbar interbody fusion (PLIF), anterior lumbar interbody fusion (ALIF), and posterolateral fusion (PLF) [18,21,[24][25][26]29,30]. However, to our knowledge only one study has reported on the treatment of rLDH using transforaminal lumbar interbody fusion (TLIF) [17].…”

Section: Introductionmentioning

confidence: 97%

“…In patients with symptomatic rLDH who do not respond to non-operative treatment, operative treatment can be considered. However, there are differing opinions regarding the appropriate surgical treatment for rLDH [11,13,14,[17][18][19][20][21][22][23][24][25][26]. Some authors believe that repeat discectomy is the treatment of choice and provides similar clinical outcomes to primary discectomy [13,14,20], but potential approach-related complications and segmental instability should be taken into consideration [14,27].…”

Section: Introductionmentioning

confidence: 98%

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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: Introductionmentioning

confidence: 97%

Section: Introductionmentioning

confidence: 98%

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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“…Theoretically, the advantages of applying interbody fusion are not in agreement with practical disadvantages such as elimination of segmental motion, increased low back pain, infections, malposition of the screws etc. [22,23].…”

Section: Resultsmentioning

confidence: 99%

Recurrence Rate of Lumbar Disc Herniation After Standard Discectomy and Microdiscectomy: A 5-Year Study

Ovcharov

Valkov

Mladenovski

et al. 2019

Journal of Biomedical and Clinical Research

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Summary Lumbar disc herniation (LDH) is the most common pathology in young people, as well as people of active age. Despite sophisticated and new minimally invasive surgical techniques and approaches, reoperations for recurrent lumbar disc herniation (rLDH) could not be avoided. LDH recurrence rates, reported in different studies, range from 5 to 25%. The purpose of this study was to estimate the recurrence rates of LDH after standard discectomy (SD) and microdiscectomy (MD), and compare them to those reported in the literature. Retrospectively, operative reports for the period 2012-2017 were reviewed on LDH surgeries performed at the Neurosurgery Clinic of Dr Georgi Stranski University Hospital in Pleven. Five hundred eighty-nine single-level lumbar discectomies were performed by one neurosurgeon. The diagnoses of recurrent disc herniation were based on the development of new symptoms and magnetic resonance/computed tomography (MRI/CT) images showing compatible lesions in the same lumbar level as the primary lumbar discectomies. The recurrence rate was determined by using chi-square tests and directional measures. SD was the most common procedure (498 patients) followed by MD (91 patients). The cumulative reoperation rate for rLDH was 7.5%. From a total number of reoperations, 26 were males (59.1%) and 18 were females (40.9%). Reoperation rates were 7.6% and 6.6% after SD and MD respectively. The recurrence rate was not significantly higher for SD. Our recurrence rate was 7.5%, which makes it comparable with the rates of 5-25% reported in the literature.

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“…Addition of a fusion to the revision discectomy has been advocated in the presence of segmental instability, chronic back pain, and CES. 1,4,6,10 The rationale for fusion in CES caused by recurrent disc herniation is that complete disc material clearance with fusion eliminates the potential for recurrent disc herniation. Furthermore, the disc space is stabilized, removing a further potential pain source should the patient experience ongoing low-back pain.…”

Section: Discussionmentioning

confidence: 99%

Anterior lumbar discectomy and fusion for acute cauda equina syndrome caused by recurrent disc prolapse: report of 3 cases

Tan

Sewell

Markmann

et al. 2017

Journal of Neurosurgery: Spine

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There is a lack of information and consensus regarding the optimal treatment for recurrent disc herniation previously treated by posterior discectomy, and no reports have described an anterior approach for recurrent disc herniation causing cauda equina syndrome (CES). Revision posterior decompression, irrespective of the presence of CES, has been reported to be associated with significantly higher rates of dural tears, hematomas, and iatrogenic nerve root damage. The authors describe treatment and outcomes in 3 consecutive cases of patients who underwent anterior lumbar discectomy and fusion (ALDF) for CES caused by recurrent disc herniations that had been previously treated with posterior discectomy. All 3 patients were operated on within 12 hours of presentation and were treated with an anterior retroperitoneal lumbar approach. Follow-up ranged from 12 to 24 months. Complete retrieval of herniated disc material was achieved without encountering significant epidural scar tissue in all 3 cases. No perioperative infection or neurological injury occurred, and all 3 patients had neurological recovery with restoration of bladder and bowel function and improvement in back and leg pain. ALDF is one option to treat CES caused by recurrent lumbar disc prolapse previously treated with posterior discectomy. The main advantage is that it avoids dissection around epidural scar tissue, but the procedure is associated with other risks and further evaluation of its safety in larger series is required.

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The Role of Fusion for Recurrent Disk Herniations

Cited by 21 publications

References 50 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

Recurrence Rate of Lumbar Disc Herniation After Standard Discectomy and Microdiscectomy: A 5-Year Study

Anterior lumbar discectomy and fusion for acute cauda equina syndrome caused by recurrent disc prolapse: report of 3 cases

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