The method of fusion chosen by the surgeon is tailored to each individual and dependent on several factors. Recent efforts in orthopedic research have generated insights into the efficacy, safety, and preferred methodology in dealing with recurrent postdiscectomy lumbar disc herniation ldh. Recurrent lumbar disc herniation after tubular microdiscectomy. The lumbar spine is made up of 5 load transferring bones called vertebrae. Figure 2 the technical note for repeated microendoscopic discectomy for recurrent lumbar disc herniation is displayed using a schematic diagram.
Motor control exercise for symptomatic lumbar disc herniation. Recurrent lumbar disc herniation is the most common complication after discectomy. Lumbar disc herniation ldh is the most common reason for performing lumbar spine surgery. However, recurrent disc herniation is a timedependent event that increases with time after surgery, and the length of followup varied across these studies. Differentiation between postoperative scar and recurrent disk herniation. Recurrent lumbar disc herniation rldh is the most common indication for reoperation after a lumbar discectomy. Isass policy guideline surgical treatment of lumbar disc. Management of recurrences is controversial due to a lack of highlevel evidence. This treatment may be followed by surgical reexploration in those individuals whose symptoms remain unresponsive. Factors that influence recurrent lumbar disc herniation hkmj. The proportion of patients having a second surgery within 2 years varies in the literature between 0. Various techniques have been used, including transforaminal lumbar interbody fusion tlif, posterior lumbar interbody fusion plif, anterior lumbar interbody fusion alif, and posterolateral fusion plf.
Recurrent herniation of the nucleus pulposus hnp and subsequent disc degeneration after a discectomy is a common problem, with reported rates ranging from 2% to 25%. Recurrent disc herniation is a less subjective and more standardized end point, strengthening the comparison made between treatment cohorts in this study. Nevertheless, these procedures correlate with a recurrence rate at 1 year that ranges from 1% to 21%. Interbody fusion is commonly associated with better fusion potentials through applying the bone graft in the load. According to the literature information, 1030% of patients who underwent lumbar discectomy still complain leg and back pain, but recurrent disc herniation rate is 515%.
To identify the risk factors and surgical management for recurrent lumbar disc herniation using a. The differential diagnoses include retained fragments, spinal stenosis. Despite optimal patient selection and surgical technique, the recurrence rate of lumbar disc herniation after lumbar microdiscectomy has been reported as high as 26% 2. View full article html enhanced article html get pdf 666k get pdf 666k. May 23, 2016 intervertebral disc herniation is one of the most common causes of back and extremity pain. Recurrent lumbar disc herniation ldh is a common cause of poor outcomes after lumbar discectomy surgery. Lumbar disc herniation ldh, a common disease, is often treated conservatively, frequently resulting in spontaneous resorption of the herniated disc. Studies focused on risk factors of true recurrent disk herniation at the same level and side, are few. They are stacked in a column with an intervertebral disc sandwiched between each set of vertebrae. Recurrent versus primary lumbar disc herniation surgery. The patient with a symptomatic recurrent disc herniation typically undergoes several weeks or months of conservative management.
Pdf recurrent lumbar disc herniation recurrence after. Fifty recurrences were treated in 46 patients, an average of 7 years and 1 month after the previous laminectomy range 3 months22 years and 11 months. S1 disc herniation two lumbar spine films were taken which revealed the following. Disc height and segmental motion as risk factors for recurrent lumbar disc herniation. The paraspinal muscles are first moved in the original incision and the secondary expansion tube is. Apr 27, 2018 although microendoscopyassisted lumbar discectomy for lateral or extraforaminal lumbar disc herniations via the lateral approach has previously been reported, microendoscopyassisted lumbar discectomy for central or paramedian disc herniations via the lateral approach has not been reported.
Background lumbar disc herniation ldh is a common indication for lumbar spine surgery. The reported incidence of these recurrent lumbar disc herniations ranges from 5% to 15%. Recurrent lumbar disc herniations are one cause of the failed back surgery syndrome. Secondary analysis of data from a concurrent randomized trial and cohort study. This study is to determine the functional outcome after fenestration discectomy for recurrent lumbar disc herniation. Recurrent disc herniation reported between 515% maine lumbar spine study. It may result in back pain, pain or sensation in different parts of the body, and physical disability. We analyse early recurrent ldh by analysis of data from the german spine register. This study identified risk factors and postoperative indicators for recurrent lumbar disc herniations rldh following microdiscectomy. Pdf the optimal surgical treatment of recurrent lumbar disc herniation is controversial. Incidence of early postoperative complications requiring. It is defined as displacement of disc components beyond the intervertebral disc space. Dr saeed kohan, fracs recurrent neurosurgery sydney. Recurrent lumbar disc herniation after conventional.
Minimally invasive tubular microdiscectomy for recurrent. The role of fusion for recurrent disk herniations sciencedirect. Today, many are managed utilizing a microdiscectomy approach. Pdf ipsilateral recurrent lumbar disc herniation gianluca. Recurrent upper lumbar disc herniation treated via the. May 01, 2005 17 yorimitsu e, chiba k, toyama y, hirabayashi k. Predisposition poor ergonomics recurrent lumbar disc. Pdf clinical characteristics of contralateral recurrent. Pdf recurrent lumbar disc herniation ldh is a common cause of poor outcomes after lumbar discectomy surgery. Fortysix patients who had previously undergone laminectomy and discectomy for lumbar disc herniation were treated for recurrent disc herniation by repeat laminectomy and discectomy. S urgery for recurrent lumbar disc herniation ldh is accompanied by higher morbidity rate compared with primary herniation surgery. Introduction lumbar disc herniation ldh is a common condition in adults and can impose a heavy burden on both the individual and society. We report the first case of recurrent upper lumbar disc herniation l2l3 treated with.
Incidence of low back pain after lumbar discectomy for. In our study, we aim to relate the recurrent of lumbar disc herniation with age, gender, surgical disc segment, recurrence development time and type of modic change. We report the first case of recurrent upper lumbar disc herniation. Med is a feasible surgical option for recurrent lumbar disc herniation, yielding surgical outcomes comparable to those obtained in primary lumbar disc herniation. Although microendoscopyassisted lumbar discectomy for lateral or extraforaminal lumbar disc herniations via the lateral approach has previously been reported, microendoscopyassisted lumbar discectomy for central or paramedian disc herniations via the lateral approach has not been reported. To assess the outcome after surgery of recurrent lumbar and sciatic pain in a patient population where long term nonsurgical measures have failed.
Motor control exercise for symptomatic lumbar disc. To compare prospectively the clinical outcomes of surgical. Various conservative treatments have been recommended for the treatment of ldh and physical therapy plays a major role in the. Outcomes in one series approached those after the initial operations, although this is not the case in the experience of most surgeons. Percutaneous endoscopic lumbar discectomy for recurrent. Repeated microendoscopic discectomy for recurrent lumbar disk. Excess weight makes one more likely to experience a lumbar herniated disc and 12 times more likely to have the same disc herniate again, called a recurrent disc herniation, after a microdiscectomy surgery. Thus, recurrent disc herniation is the primary cause of surgical failure and morbidity in patients treated with a lumbar discectomy. Data from patients undergoing disc herniation surgery in the lumbar region were extracted from the german spine registry. Treating a second disc herniation after spine surgery. Recurrence rate of lumbar disc herniation after standard. Spinal disc herniation is an injury to the cushioning and connective tissue between vertebrae, usually caused by excessive strain or trauma to the spine.
Longterm outcomes of surgical and nonsurgical management of lumbar spinal stenosis. Reported incidences of recurrent lumbar disc herniation vary between 3% and 18%, reflecting variability in followup, surgical technique, and management paradigms among studies 5,7. A novel surgical technique to treat primary, recurrent. Increased risk of recurrent herniation poor healing of annulus and ligament animal models shown to have lower type i collagen extracelluar matrix component via vasoconstriction and reduced oxygenation. Factors that may add to the risk of developing a lumbar herniated disc include. Various conservative treatments have been recommended for the treatment of ldh and physical therapy plays a major role in the management of patients. Recurrent disc herniation following previous disc surgery occurs in 5 to 15% of cases. Lumbar interbody fusion procedure is a recognized surgical technique in management of a variety of lumbar pathologies including recurrent lumbar disc prolapse. Several studies have not found any relevant outcome differences between.
Clinical characteristics of contralateral recurrent lumbar disc herniation at the same level a retrospective controlled study. There is intermediate levels iii to iv evidence detailing perioperative risk factors and the optimal surgical technique for recurrent lumbar disc herniations. Although various factors contribute to the failure of disc surgery, recurrent disc herniation remains the major source of disability. Nov 04, 2017 recurrent lumbar disc herniation rldh is the most common indication for reoperation after a lumbar discectomy.
It has been noted to occur in 5 to 15% of cases surgically treated for primary lumbar disc herniation. Pain recurrence after discectomy for symptomatic lumbar disc. Recurrent lumbar disc herniation has been reported in widely varying incidences between 3% and 18% of the patients and depends on the duration of the followup. Recurrent lumbar disc herniation rldh is a common complication following primary. The incidence of this phenomenon, however, remains unknown. Epidural scar tissue increases the risk of dural tear and nerve root injury. The most common risk factor is being between the ages of 35 and 50. Utilizing a multivariate analysis, higher body mass index bmi and.
Pdf risk factors of recurrent lumbar disk herniation. Incidence of spontaneous resorption of lumbar disc herniation. Lumbar disc herniation is an important health problem, with recurrence rates ranging from 5% to 15%. This is often treated by further surgical intervention where. The journal will consider submissions in areas on craniocervical to lumbosacral spine including the followings. Predisposition, poor ergonomics, recurrent lumbar disc herniation. Lumbar disc herniation ldh is the most common pathology in young people, as well as people of active age. Longterm outcomes of standard discectomy for lumbar disc herniation. Differentiation between postoperative scar and recurrent. Interbody fusion augmented by pedicle screw fixation has been considered to improve fusion rates and clinical outcomes. Intervertebral disc herniation is one of the most common causes of back and extremity pain. Outcome after surgery of recurrent lumbar disc disease. Recurrent lumbar disc herniation is a common disease process. Although data are limited, a few investigators have reported outcomes after fusion for recurrent disk herniation.
Due to the altered anatomy with the presence of scar tissue, the surgica we describe the microsurgical revision technique step by step with the evaluation of our own clinical results in comparison with primary lumbar disc surgeries. Despite sophisticated and new minimally invasive surgical techniques and approaches, reoperations for recurrent lumbar disc herniation rldh could not be avoided. Currently, there arent any guidelines to assist surgeons in determining which approach is most appropriate to treat rdh. Percutaneous endoscopic lumbar discectomy for recurrent lumbar disc herniation. Recurrent lumbar disc herniation rldh is defined as disc herniation at the same level, regardless of ipsilateral or contralateral herniation, in a patient who has experienced a painfree interval of at least 6 months after surgery.
Treatment for recurrent lumbar disc herniation ncbi. Microendoscopic discectomy for recurrent lumbar disc herniation. Additionally, manual searches of the references cited in all the relevant. Recurrent lumbar disc herniation is an important problem in spinal surgery. Survival analysis is a better estimate of recurrent disc. Costutility analysis for recurrent lumbar disc herniation. A consecutive series of 25 patients who underwent posterior microendoscopic discectomy for recurrent lumbar disc herniation were included. Lumbar disc herniation ldh is a localized displacement of intervertebral disc material beyond the normal perimeter of the disc space. The removal of recurrent lumbar disc herniations requires meticulous surgical. The most conclusive diagnostic tool for disc herniation is mri, and treatment may range from painkillers to surgery.
The related article function was also used to broaden the search. Miniopen anterior lumbar interbody fusion for recurrent. Costeffectiveness analyses are useful when making clinical. Manual muscle testing, sensory testing, supine straight leg. The rate of recurrent disc herniation after lumbar disc ectomy is 5 to 15%. However, samelevel recurrent lumbar disc herniation may complicate outcomes in a subset of patients. The aim of current study is to evaluate risk factors of recurrent disc herniation in iranian population. The rate of recurrent disc herniation after lumbar discectomy is 5 to 15%.
Recurrent herniation of the nucleus pulposus hnp and subsequent disc degeneration after a discectomy is a common problem. To analyze the incidence of spontaneous resorption after conservative treatment of ldh using computed tomography and magnetic. Analysis of risk factors and postoperative predictors for. Ldh recurrence rates, reported in different studies, range from 5 to 25%. Management of recurrent unilateral lumbar disc herniation in.
Preoperative estimation of disc herniation recurrence after microdiscectomy. The recurrence rate in lumbar disc herniations ldh has been reported between 5 and 25%. Outcome after surgery of recurrent lumbar disc disease salman a jaffery department of neurosurgery,women medical college abbottabad abstract year. Repeated microendoscopic discectomy for recurrent lumbar. As part of our analysis we were able to assess the effect of age, gender and level of primary protrusion on the occurrence of a revision. In this study group, a mean in this study group, a mean of 48 years of age and modic changes in the primary surgery were observed. The most commonly used surgical treatment is lumbar discectomy.
Most common operations of spine most significant long term risk. The epidemiology and pathophysiology of lumbar disc. Lumbar posterior spinal fusion can be performed several ways. The paraspinal muscles are first moved in the original incision and the secondary expansion tube is inserted and propped against the vertebral plate. Diagnosis and treatment of lumbar disc herniation with. A disc herniation is typically treated with nonsurgical intervention techniques, like physical therapy, corticosteroid injections, chiropractic manipulation and antiinflammatory medications. May 21, 2018 the recurrence rate in lumbar disc herniations ldh has been reported between 5 and 25%.
The lumbar spine comprises the 5 vertebrae that are below the thoracic vertebrae and. There are only few data about this phenomenon that occurs within days of the initial operation. Identification and dissection of scar from the dura mater is great ly aided with the use of a microscope. The computer search was supplemented with manual searches of reference lists of all retrieved. The aim of this study was to determine risks and predictors of recurrent pain following standard open discectomy for subacutechronic symptomatic lumbar disc herniation sldh. Herniated discs usually respond to the treatment, but if they dont, surgery may be performed. The microsurgical technique for herniated lumbar disc operations.
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