Asymptomatic Same-Site Recurrent Disc Herniation After Lumbar Discectomy

Abstract Objective: To investigate the effect of Modic changes (MCs) and the herniated disc component on recurrent lumbar disc herniation (rLDH) following percutaneous endoscopic lumbar discectomy (PELD).Methods: We included 102 (65 males,37 females, aged 20–66 yr) inpatients who underwent PELD from August 2013 to August 2016. All patients underwent CT and MRI preoperative. The presence and type of Modic changes were assessed. During surgery the herniated disc component of each patient was classified into two groups: Nucleus pulposus group, Hyaline cartilage group. The association of herniated disc component with Modic changes was investigated. The incidence of recurrent disc herniation was assessed on more than 2-year follow-up.Results: In total, 11 patients were lost to follow up; the other 91 were followed up for 24–60 months. Of the 91 patients, 99 discs underwent PELD; 28/99 (28.3%) had MCs. Type I and II MCs were seen in 9 (9.1%) and 19 (19.2%), respectively; no type III MCs were found. Among 28 endplates with MCs, according to the herniated disc component, 18/28 (64.3%) showed evidence of hyaline cartilage in the intraoperative specimens, including 6/9 and 12/19 endplates with type I and II MCs, respectively. Among 71 endplates without MCs, 14/71 (19.7%) showed evidence of hyaline cartilage in the intraoperative specimens. Hyaline cartilage was more common in patients with MCs (P<0.05). We found 2 cases of rLDH in the non-MC group (n=71); 6 cases rLDH were found in the MC group (n=28), including 2 and 4 cases for types I and II, respectively. There was no significant difference between types I and II (P>0.05). rLDH was more common in patients with MCs (P<0.05). We found 5 rLDH cases in the hyaline cartilage group (n=32); 3 rLDH cases were found in the nucleus pulposus group (n=67). rLDH was more common in the hyaline cartilage group (P<0.05). Conclusions: MCs were associated with the herniated cartilage disc component. rLDH following PELD preferentially occurs when MCs or the herniated cartilage are present.

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RECURRENT DISC HERNIATION AND LONG-TERM BACK PAIN AFTER PRIMARY LUMBAR DISCECTOMY

Neurosurgery ◽

10.1227/01.neu.0000337574.58662.e2 ◽

2009 ◽

Vol 64 (2) ◽

pp. 338-345 ◽

Cited By ~ 131

Author(s):

Matthew J. McGirt ◽

Giannina L. Garcés Ambrossi ◽

Ghazala Datoo ◽

Daniel M. Sciubba ◽

Timothy F. Witham ◽

...

Keyword(s):

Back Pain ◽

Disc Herniation ◽

Lumbar Disc ◽

Lumbar Discectomy ◽

Leg Pain ◽

Medline Search ◽

Recurrent Disc Herniation ◽

Herniated Lumbar Disc ◽

Short And Long Term

Abstract OBJECTIVE It remains unknown whether aggressive disc removal with curettage or limited removal of disc fragment alone with little disc invasion provides a better outcome for the treatment of lumbar disc herniation with radiculopathy. We reviewed the literature to determine whether outcomes reported after limited discectomy (LD) differed from those reported after aggressive discectomy (AD) with regard to long-term back pain or recurrent disc herniation. METHODS A systematic MEDLINE search was performed to identify all studies published between 1980 and 2007 reporting outcomes after AD or LD for a herniated lumbar disc with radiculopathy. The incidence of short- and long-term recurrent back or leg pain and recurrent disc herniation was assessed from each reported LD or AD cohort and the cumulative incidence compared. RESULTS Fifty-four studies (60 discectomy cohorts) met the inclusion criteria, reporting the outcomes of 13 359 patients after lumbar discectomy (LD, 6135 patients; AD, 7224 patients). The reported incidence of short-term recurrent back or leg pain was similar after LD (mean, 14.5%; range, 7–16%) and AD (mean, 14.1%; range, 6–43%) (P < 0.01). However, more than 2 years after surgery, the reported incidence of recurrent back or leg pain was 2.5-fold less after LD (mean, 11.6%; range, 7–16%) compared with AD (mean, 27.8%; range, 19–37%) (P < 0.0001). The reported incidence of recurrent disc herniation after LD (mean, 7%; range, 2–18%) was greater than that reported after AD (mean, 3.5%; range, 0–9.5%) (P < 0.0001). CONCLUSION Review of the literature demonstrates a greater reported incidence of long-term recurrent back and leg pain after AD but a greater reported incidence of recurrent disc herniation after LD. Prospective, randomized trials are needed to firmly assess this possible difference.

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Percutaneous Endoscopic Lumbar Discectomy for Recurrent Disc Herniation: Surgical Technique, Outcome, and Prognostic Factors of 43 Consecutive Cases

Spine ◽

10.1097/01.brs.0000134591.32462.98 ◽

2004 ◽

Vol 29 (16) ◽

pp. E326-E332 ◽

Cited By ~ 162

Author(s):

Yong Ahn ◽

Sang-Ho Lee ◽

Woo-Min Park ◽

Ho-Yeon Lee ◽

Song-Woo Shin ◽

...

Keyword(s):

Prognostic Factors ◽

Surgical Technique ◽

Disc Herniation ◽

Lumbar Discectomy ◽

Percutaneous Endoscopic Lumbar Discectomy ◽

Recurrent Disc Herniation ◽

Endoscopic Lumbar Discectomy

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P29. Recurrent Disc Herniation and Long-Term Back Pain after Primary Lumbar Discectomy: Review of Outcomes Reported for Limited or Aggressive Disc Removal

The Spine Journal ◽

10.1016/j.spinee.2009.08.287 ◽

2009 ◽

Vol 9 (10) ◽

pp. 130S ◽

Cited By ~ 3

Author(s):

Matthew McGirt ◽

Giannina Garces-Ambrossi ◽

Ghazala Datoo ◽

Daniel Sciubba ◽

Timothy Witham ◽

...

Keyword(s):

Back Pain ◽

Disc Herniation ◽

Lumbar Discectomy ◽

Recurrent Disc Herniation

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RECURRENT LUMBAR DISC HERNIATION AFTER SINGLE-LEVEL LUMBAR DISCECTOMY

Neurosurgery ◽

10.1227/01.neu.0000350224.36213.f9 ◽

2009 ◽

Vol 65 (3) ◽

pp. 574-578 ◽

Cited By ~ 104

Author(s):

Giannina L. Garcés Ambrossi ◽

Matthew J. McGirt ◽

Daniel M. Sciubba ◽

Timothy F. Witham ◽

Jean-Paul Wolinsky ◽

...

Keyword(s):

Health Care ◽

Health Care Costs ◽

Lumbar Disc Herniation ◽

Disc Herniation ◽

Lumbar Disc ◽

Lumbar Discectomy ◽

Single Level ◽

Recurrent Disc Herniation ◽

Care Costs ◽

Recurrent Lumbar Disc Herniation

Abstract OBJECTIVE Same-level recurrent lumbar disc herniation complicates outcomes after primary discectomy in a subset of patients. The health care costs associated with the management of this complication are currently unknown. We set out to identify the incidence and health care cost of same-level recurrent disc herniation after single-level lumbar discectomy at our institution. METHODS We retrospectively reviewed 156 consecutive patients undergoing primary single-level lumbar discectomy at one institution. The incidence of symptomatic same-level recurrent disc herniation either responding to conservative therapy or requiring revision discectomy was assessed. Institutional billing and accounting records were reviewed to determine the billing costs of all diagnostic and therapeutic measures used for patients experiencing recurrent disc herniation. RESULTS Twelve months after surgery, 141 patients were available for follow-up. Of these patients, 124 (88%) were symptom free or had minimal symptoms not affecting their daily activity. Radiographically proven symptomatic same-level recurrent disc herniation developed in 17 patients (12%) a median of 8 months after primary discectomy. Eleven patients (7%) required revision surgery, whereas 6 (3.9%) responded to conservative therapy alone. Diagnosis and management of recurrent disc herniation were associated with a mean cost of $26 593 per patient, and the mean cost was markedly less for patients responding to conservative treatment ($2315) compared with those requiring revision surgery ($39 836) (P < 0.001). Of 141 primary lumbar discectomies performed at our institution with the patients followed for 1 year, the total cost associated with the management of subsequent recurrent disc herniation was $452 083 ($289 797 per 100 primary discectomies). CONCLUSION In our experience, recurrent lumbar disc herniation occurred in more than 10% of patients and was associated with substantial health care costs. Development of novel techniques to prevent recurrent lumbar disc herniation is warranted to decrease the health care costs and morbidity associated with this complication. Prolonged conservative management should be attempted when possible to reduce the health care costs of this complication.

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