Recurrent lumbar disc herniation - Results of operative management

Study Design. A retrospective evaluation of 28 patients with recurrent lumb ar disc herniation. Objectives. To analyze the outcome of the revisions (re peat discectomy), the risk factors of recurrent disc herniation, and the fa ctors that influenced the outcomes of repeat discectomy. Summary of Background Data. Recurrent herniation following disc excision ha s been reported in 5-11% of patients. There have been many studies on recur rent disc herniation, but these studies have analyzed mixed patient populat ions. Methods. Recurrent lumbar disc herniation was defined as disc herniation at the same level, regardless of ipsilateral or contralateral herniation, wit h a pain-free interval greater than 6 months. Eight women and 20 men were s tudied. The levels of disc herniation were L4-L5 (19 cases) and L5-S1 (9 ca ses). Gadolinium-enhanced magnetic resonance imaging was performed in all p atients. Revision surgery was performed in all patients by using convention al open discectomy. The pain-free interval, side and degree of herniation, operation time, duration of hospital stay, and clinical improvement rate we re recorded. Results. The mean pain-free interval was 60.8 months. There were 21 cases o f ipsilateral herniation and 7 cases of contralateral herniation. The degre es of herniation in revision were protrusion (14 cases), subligamentous ext rusion (3 cases), transligamentous extrusion (8 cases), and sequestration ( 3 cases). The degrees of herniation in the previous discectomy were protrus ion (17 cases), subligamentous extrusion (10 cases), and transligamentous e xtrusion (1 case). The length of surgery was significantly different (P = 0 .003) between the revision surgery and the previous discectomy. There were no significant differences between revision and previous surgery in terms o f hospital stay or clinical improvement rates. Age, gender, smoking, profes sions, traumatic events, level and degree of herniation, and pain-free inte rval did not affect the clinical outcomes. Conclusion. Conventional open discectomy as a revision surgery for recurren t lumbar disc herniation showed satisfactory results that were comparable w ith those of primary discectomy. Based on the results of this study, repeat discectomy can be recommended for the management of recurrent lumbar disc herniation.