Contralateral recurrent lumbar disc herniation - Results of discectomy compared with those in primary herniation

Study Design. The surgical outcomes of patients who underwent discectomy fo r contralateral recurrent herniation and primary herniation were evaluated. Objective. To assess whether the clinical results in patients undergoing su rgery for contralateral recurrent disc herniation may be as good as those r eported after primary discectomy. Summary of Background Data. No retrospective or prospective investigation h as been conducted on the surgical treatment of contralateral recurrent lumb ar disc herniation. Methods. Sixteen patients who underwent surgery for recurrent disc herniati on at the same level as primary disc excision, but on the opposite side, we re analyzed prospectively from the recurrence of contralateral radicular pa in (Group 1). All patients had reported a satisfactory result after primary discectomy. Fifty consecutive patients who underwent disc excision during the study period, who did not report recurrent radicular pain, were analyze d for comparison (Group 2). Overall patient satisfaction, pain severity, fu nctional outcome, and work status were evaluated. Results. At the 2-year follow-up, the clinical outcome was rated as satisfa ctory in 14 of 16 patients in Group 1 and in 45 of 50 in Group 2 (P > 0.05) . Twelve patients in Group 1 and 42 in Group 2 had resumed their work or da ily activities at the same level as before the operation (P > 0.05). Radicu lar pain was significantly improved in both groups at the 6-month and 2-yea r follow-ups. At the a-month follow-up, low back pain was significantly imp roved only in the patients in Group 2; however, at the 2-year follow-up, lo w back pain was significantly improved in both groups. Conclusions. Clinical results in patients reoperated on for contralateral r ecurrent lumbar disc herniation compare favorably with those reported after primary discectomy. The improvement of pain in the low back and lower limb s reported by the majority of patients 2 years after reoperation suggests t hat fusion is not needed in this patient population.