Clinical Outcomes after Microdiscectomy for Recurrent Lumbar Disk Herniation: A Single-Center Study

Document Type : RESEARCH PAPER

Authors

1 Department of Neurological Surgery, Ghaem Hospital, Mashhad University of Medical Sciences (MUMS), Mashhad, Iran

2 Department of Cardiology, Ghaem Hospital, Mashhad University of Medical Sciences (MUMS), Mashhad, Iran

Abstract

Background: Revision discectomy is the principal procedure for recurrent lumbar disk herniation (RLDH). The clinical
outcomes after this procedure are as good as or slightly poorer than those produced by primary discectomy. In this
study, the clinical outcomes of patients treated with microsurgical discectomy for RLDH were analyzed.
Methods: We examined 179 patients undergoing lumbar microdiscectomy surgery for RLDH. The visual analogue
scale (VAS), Prolo scoring system, and Oswestry Disability Index (ODI) were used for evaluating the improvement
of symptoms and functional outcomes.
Results: Among 179 patients, 101 (56%) obtained good and excellent Prolo scores (group 1), while 78 (44%)
obtained fair or poor results (group 2). There was no significant difference between the groups regarding age
(P=0.515), gender (P=0.545), body mass index (P=0.523), diabetes mellitus (P=0.074), smoking (P=0.100),
interval between primary and revision surgeries (P=0.749), and surgical outcomes (P=0. 749). However, significant
improvements were achieved in VAS scores for back (P=0.197) and radicular pain (P=0.606), as well as ODI scores
(P= 0.000). Based on the findings, only ODI scores showed a significant inter-group difference in the 12-month
follow-up (P=0.038).
Conclusion: Limited microsurgical discectomy could be considered as the main surgical method in patients with RLDH
without overt instabilities.
Level of evidence: IV

Keywords

Main Subjects

References

1. Suk KS, Lee HM, Moon SH, Kim NH. Recurrent lumbar
disc herniation: results of operative management.
Spine. 2001; 26(6):672-6.
2. Dai LY, Zhou Q, Yao WF, Shen L. Recurrent lumbar
disc herniation after discectomy: outcome of repeat
discectomy. Surg Neurol. 2005; 64(3):226-31.
3. Dower A, Chatterji R, Swart A, Winder MJ. Surgical
management of recurrent lumbar disc herniation and
the role of fusion. J Clin Neurosci. 2016; 23(4):44-50.
4. Law JD, Lehman RA, Kirsch WM. Reoperation after
lumbar intervertebral disc surgery. J Neurosurger.
1978; 48(2):259-63.
5. Ebeling U, Kalbarcyk H, Reulen HJ. Microsurgical
reoperation following lumbar disc surgery: timing,
surgical findings, and outcome in 92 patients. J
Neurosurg. 1989; 70(3):397-404.
6. Gaston P, Marshall RW. Survival analysis is a better
estimate of recurrent disc herniation. J Bone Joint
Surg Br. 2003; 85(4):535-7.
7. Buchmann N, Preuß A, Gempt J, Ryang YM, Vazan M,
Stoffel M, et al. Outcome after surgical treatment for
late recurrent lumbar disc herniations in standard
open microsurgery. World Neurosurg. 2016;
89(2):382-6.
8. Palma L, Carangelo B, Muzii VF, Mariottini A, Zalaffi
A, Capitani S. Microsurgery for recurrent lumbar disk
herniation at the same level and side: do patients fare
worse? Experience with 95 consecutive cases. Surg
Neurol. 2008; 70(6):619-21.
9. Patel M, Braybrooke J, Newey M, Sell P. A comparative
study of the outcomes of primary and revision lumbar
discectomy surgery. Bone Joint J. 2013; 95(1):90-4.
10. Fairbank JC, Pynsent PB. The Oswestry disability
index. Spine. 2000; 25(22):2940-52.
11. Vanti C, Prosperi D, Boschi M. The Prolo Scale: history,
evolution and psychometric properties. J Orthop
Traumatol. 2013; 14(4):235-45.
12. Mullin BB, Rea GL, Irsik R, Catton M, Miner ME. The
effect of postlaminectomy spinal instability on the
outcome of lumbar spinal stenosis patients. J Spinal
Disord. 1996; 9(2):107-16.
13. Grogan J, Nowicki BH, Schmidt TA, Haughton VM.
Lumbar facet joint tropism does not accelerate
degeneration of the facet joints. AJNR Am J
Neuroradiol. 1997; 18(7):1325-9.
14. Mroz TE, Lubelski D, Williams SK, O’Rourke C,
Obuchowski NA, Wang JC, et al. Differences in the
surgical treatment of recurrent lumbar disc herniation
among spine surgeons in the United States. Spine J.
2014; 14(10):2334-43.
15. Hackla S, Malik FH, Basu S, Gupta AK. Correlation
of canal dimension with neurological status and
surgical outcome in lumbar pivd. J Orthop Ther. 2018;
(10):2575-8241.
16. Baba H, Chen Q, Kamitani K, Imura S, Tomita K.
Revision surgery for lumbar disc herniation. Int
Orthop. 1995; 19(2):98-102.
17. Fu TS, Lai PL, Tsai TT, Niu CC, Chen LH, Chen WJ. Longterm
results of disc excision for recurrent lumbar disc
herniation with or without posterolateral fusion.
Spine. 2005; 30(24):2830-4.
18. Guan J, Ravindra VM, Schmidt MH, Dailey AT, Hood
RS, Bisson EF. Comparing clinical outcomes of
repeat discectomy versus fusion for recurrent disc
herniation utilizing the N2QOD. J Neurosurg Spine.
2017; 26(1):39-44.
19. Ibrahim M, Arockiaraj J, Amritanand R, Venkatesh K,
David KS. Recurrent lumbar disc herniation: results of
revision surgery and assessment of factors that may
affect the outcome. A non-concurrent prospective
study. Asian Spine J. 2015; 9(5):728-36.
20. Guo JJ, Yang H, Tang T. Long-term outcomes of the
revision open lumbar discectomy by fenestration: A
follow-up study of more than 10 years. Int Orthop.
2009; 33(5):1341-5.
21. Ozgen S, Naderi S, Ozek MM, Pamir MN. Findings and
outcome of revision lumbar disc surgery. J Spinal
Disord. 1999; 12(4):287-92.
22. Wera GD, Marcus RE, Ghanayem AJ, Bohlman HH.
Failure within one year following subtotal lumbar
discectomy. J Bone Joint Surg Am. 2008; 90(1):10-5.
23. Lee DY, Shim CS, Ahn Y, Choi YG, Kim HJ, Lee SH.
Comparison of percutaneous endoscopic lumbar
discectomy and open lumbar microdiscectomy for
recurrent disc herniation. J Korean Neurosurg Soc.
2009; 46(6):515-21.
24. McGirt MJ, Ambrossi GL, Datoo G, Sciubba DM, Witham
TF, Wolinsky JP, et al. Recurrent disc herniation
and long‐term back pain after primary lumbar
discectomy: review of outcomes reported for limited
versus aggressive disc removal. Neurosurgery. 2009;
64(2):338-45.
25. El Shazly AA, El Wardany MA, Morsi AM. Recurrent
lumbar disc herniation: a prospective comparative
study of three surgical management procedures.
Asian J Neurosurg. 2013; 8(3):139-46.
The Archives of Bone and Joint Surgery
Volume 6, Issue 5
September 2018
Pages 397-401

Files

History

  • Receive Date: 28 July 2017
  • Revise Date: 25 October 2017
  • Accept Date: 12 November 2017

Share

How to cite

Statistics