The Outcomes of Surgical Treatment of Recurrent Lumbar Disk Herniation with Discectomy Alone and Discectomy with Posterolateral Interbody Fusion
Novelty in Biomedicine,
Vol. 2 No. 1 (2014),
28 April 2014
,
Page 10-17
https://doi.org/10.22037/nbm.v2i1.6106
Abstract
Background: Recurrent lumbar disk herniation (RLDH) is one of the major causes of failure of standard discectomy. The optimal treatment method for RLDH is controversial. In the current study, we aimed to compare the clinical and functional outcomes of treating RLDH with discectomy alone and discectomy associated with posterolateral interbody fusion (PLIF).
Material and Methods: There were 41 patients with RLHD after primary discectomy in the current retrospective study. Patients were assigned to 2 groups based on the surgical method: discectomy alone (17 patients) and discectomy with PLIF (21 patients). At the final visit the following variables were measured and compared between groups: the back and radicular pain intensity using visual analogue scale (VAS), functional outcome using oswestry low back pain disability scale (ODI), return to previous work and complication. Patients were followed for 13.9±2.8 and 15±3 months in discectomy alone and discectomy with PLIF groups, retrospectively.
Results: Complete fusion was achieved in 24 patients of PLIF group. The back pain intensity was the same; however the radicular pain intensity was significantly lower in PLIF group (1.5±0.9 V.s 2.3±1; p=0.017). Also, the mean of ODI scale was the same. 82.3% of patients in discectomy group and 87.5% of patients in PLIF group returned to previous work and the difference was not significant. One patient in discectomy group and 2 patients in PLIF group developed temporary neurological deficit which disappeared after 3 months.
Conclusions: Although both discectomy alone and discectomy with PLIF were associated with favorable mid-term results in treating patients with RLDH, however, the authors recommend using discectomy with PLIF for lower radicular pain.
- RLDH
- Discectomy
- PLIF
How to Cite
References
Mixter WJ, Barr JS. Rupture of the intervertebral disc with involvementof the spinal canal. N Engl J Med 1934;211:210-4.
Acharya KN, Nathan TS, Kumar JR, Menon KV.Primary and revision lumbar discectomy: a three-year review from one center. Indian J Orthop 2008;42(2):178-81.
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.
Morgan-Hough CV, Jones PW, Eisenstein SM.Primary and revision lumbar discectomy. A 16-year review from one centre. J Bone Joint Surg Br 2003;85(6):871-4.
Cinotti G, Roysam GS, Eisenstein SM, Postacchini F. Ipsilateral recurrent lumbar disc herniation. A prospective,controlled study. J Bone Joint Surg Br 1998;80:825-32.
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.
Suk KS, Lee HM, Moon SW, Kim NH. Recurrent lumbar disc herniation: Results of operative management. Spine 2001;26:672-6.
Fritsch EW, Jürgen H, Stefan R. The failed back syndrome: Reasons, intraoperative findings and long term results: A report of 182 operative treatments. Spine 1996;21:626-33.
Liaropolous K, Spiropoulou P, Papadakis N, Maraziotis Th, Korovessis P. Recurrence of sciatica following hemilaminectomy for disc herniation. Eur J Orthop Surg Traumatol 2003;13:235-40.
Ozgen S, Naderi S, Ozgen MM , Pamir MN. Findings and outcome of revision lumbar disc surgery. J Spinal Disord1999;12:287-92.
Ambrossi GL, McGirt MJ, Sciubba DM, Witham TF, Wolinsky JP, Gokaslan ZL, et al. Recurrent lumbar disc herniation after single-level lumbar discectomy: incidence and health care cost analysis. Neurosurgery 2009;65(3):574-8.
Tsai C-H, Hsu H-C, Chen Y-J, Lin C-J, Chen H-T. Recurrent lumbar disk herniation after discectomy: clinical results of repeated discectomy and analysis of factors affecting surgical outcome. Mid Taiwan J Med 2007;12:125-32.
Hao Y, Deng S, Li J, Ma Y. Using of transforaminal lumbar interbody fusion in lumbar revision surgery. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2011;25(1):87-90.
Swartz KR, Trost GR. Recurrent lumbar disc herniation. Neurosurg Focus2003;15(3):E10.
Gaston P, Marshall RW. Survival analysis is a better estimate of recurrent disc herniation.J Bone Joint Surg Br 2003;85(4):535-7.
Chen Z, Zhao J, Liu A, Yuan J, Li Z. Surgical treatment of recurrent lumbar disc herniation by transforaminal lumbar interbody fusion. Int Orthop 2009;33(1):197-201.
Fu TS, Lai PL, Tsai TT, Niu CC, Chen LH, Chen WJ. Long-term results of disc excision for recurrent lumbar disc herniation with or without posterolateral fusion. Spine (Phila Pa 1976) 2005;30:2830-4.
Zhuo X, Hu J, Li B, Sun H, Chen Y, Hu Z. Comparative study of treating recurrent lumbar disc protrusion by three different surgical procedures. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2009;23(12):1422-6.
Niu CC, Chen LH, Lai PL, Fu TS, Chen WJ. Single cylindrical threaded cage used in recurrent lumbar disc herniation. J Spinal Disord Tech 2005;18 Suppl:S65-72.
Brox JI, Reikerås O, Nygaard Ø, Sørensen R, Indahl A, Holm I, et al. Lumbar instrumented fusion compared with cognitive intervention and exercises in patients with chronic back pain after previous surgery for disc herniation: a prospective randomized controlled study. Pain 2006;122(1-2):145-55.
Shin KH, Chang HG, Rhee NK, Lim KS. Revisional percutaneous full endoscopic disc surgery for recurrent herniation of previous open lumbar discectomy. Asian Spine J 2011;5(1):1-9.
Deyo RA, Weinstein JN. Low back pain. N Engl J Med 2001;344:363-70.
Baba H, Chen Q, Kamitani K, Imura S, Tomita K. Revision surgery for lumbar disc herniation. An analysis of 45 patients.IntOrthop1995;19:98-102.
Papadopoulos EC, Girardi FP, Sandhu HS, Sama AA, Parvataneni HK, O'Leary PF, et al. Outcomeof revision discectomies following recurrent lumbar disc herniation. Spine 2006;31:1473-6.
Keskimaki L, Seitsalo S, Osterman H, Rissanen P. Reoperations after lumbar disc surgery. Spine 2000;25:1500-8.
Silvers HR, Lewis PJ, Asch HL, Clabeaux DE. Lumbar discectomy for recurrent disc herniation. J Spinal Disord1994;7:408-19.
Herron L. Recurrent lumbar disc herniation: results of repeat laminectomy and discectomy. J Spinal Disord 1994;7:161-6.
Stolke D, Sollmann WP, Seifert V. Intra- and postoperative complications in lumbar disc surgery. Spine 1989;14:56-9.
- Abstract Viewed: 656 times
- PDF Downloaded: 468 times