scholarly journals Clinical Outcome and Influencing Factor for Repeat Lumbar Discectomy for Ipsilateral Recurrent Lumbar Disc Herniation

2012 ◽  
Vol 9 (1) ◽  
pp. 1 ◽  
Author(s):  
Yeon Sung Jung ◽  
Hyu Jin Choi ◽  
Young-Min Kwon
Keyword(s):  
Clinical Outcome ◽  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Lumbar Disc ◽  
Influencing Factor ◽  
Lumbar Discectomy ◽  
Recurrent Lumbar Disc Herniation

scholarly journals Minimally invasive tubular microdiscectomy for recurrent lumbar disc herniation

2016 ◽  
Vol 24 (1) ◽  
pp. 48-53 ◽  
Author(s):  
Ulrich Hubbe ◽  
Pamela Franco-Jimenez ◽  
Jan-Helge Klingler ◽  
Ioannis Vasilikos ◽  
Christoph Scholz ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Minimally Invasive ◽  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Lumbar Disc ◽  
Operating Time ◽  
Leg Pain ◽  
P Value ◽  
Vas Scores ◽  
Recurrent Lumbar Disc Herniation

OBJECT The aim of the study was to investigate the safety and efficacy of minimally invasive tubular microdiscectomy for the treatment of recurrent lumbar disc herniation (LDH). As opposed to endoscopic techniques, namely microendoscopic and endoscopic transforaminal discectomy, this microscopically assisted technique has never been used for the treatment of recurrent LDH. METHODS Thirty consecutive patients who underwent minimally invasive tubular microdiscectomy for recurrent LDH were included in the study. The preoperative and postoperative visual analog scale (VAS) scores for pain, the clinical outcome according to modified Macnab criteria, and complications were analyzed retrospectively. The minimum follow-up was 1.5 years. Student t-test with paired samples was used for the statistical comparison of pre- and postoperative VAS scores. A p value < 0.05 was considered to be statistically significant. RESULTS The mean operating time was 90 ± 35 minutes. The VAS score for leg pain was significantly reduced from 5.9 ± 2.1 preoperatively to 1.7 ± 1.3 postoperatively (p < 0.001). The overall success rate (excellent or good outcome according to Macnab criteria) was 90%. Incidental durotomy occurred in 5 patients (16.7%) without neurological consequences, CSF fistula, or negative influence to the clinical outcome. Instability occurred in 2 patients (6.7%). CONCLUSIONS The clinical outcome of minimally invasive tubular microdiscectomy is comparable to the reported success rates of other minimally invasive techniques. The dural tear rate is not associated to higher morbidity or worse outcome. The technique is an equally effective and safe treatment option for recurrent LDH.

Radiological predictors of recurrent lumbar disc herniation: a systematic review and meta-analysis

2020 ◽  
pp. 1-11
Author(s):  
Michael Brooks ◽  
Ashraf Dower ◽  
Muhammad Fahmi Abdul Jalil ◽  
Saeed Kohan
Keyword(s):  
Systematic Review ◽  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Imaging Modality ◽  
Lumbar Disc ◽  
Meta Analysis ◽  
Lumbar Discectomy ◽  
Segmental Motion ◽  
Radiological Parameters ◽  
Recurrent Lumbar Disc Herniation

OBJECTIVELumbar discectomy for the management of lumbar radiculopathy is a commonly performed procedure with generally excellent patient outcomes. However, recurrent lumbar disc herniation (rLDH) remains one of the most common complications of the procedure, often necessitating repeat surgery. rLDH is known to be influenced by a variety of factors, and in this systematic review the authors aimed to explore the radiological predictors of recurrence.METHODSA systematic review and meta-analysis was conducted to identify studies analyzing radiological predictors of recurrent herniation, both ipsilateral and contralateral. A search was conducted on Medline and EMBASE. Both retrospective and prospective comparative studies were included, measuring radiological parameters of lumbar discectomy patients. All factors were considered irrespective of imaging modality, and a meta-analysis of the data was performed in which 5 or more studies were identified analyzing the same parameter.RESULTSIn total, 1626 reported studies were screened, with 23 being included in this review, of which 13 were appropriate for meta-analysis. Three factors, namely disc height index, Modic changes, and sagittal range of motion, were determined to be significantly correlated with an increased rate of rLDH. Some variables were considered in only 1 or 2 different studies, and the authors have included a narrative review of these novel findings.CONCLUSIONSThe findings of associations between the radiological parameters and rLDH implicates the role of instability in the development of recurrence. Understanding the physiological factors associated with instability is important, because although early degenerative disc changes may predispose patients to herniation recurrence, more advanced degeneration likely reduces segmental motion and concurrently risk of recurrence.

RECURRENT LUMBAR DISC HERNIATION AFTER SINGLE-LEVEL LUMBAR DISCECTOMY

Neurosurgery ◽  
2009 ◽  
Vol 65 (3) ◽  
pp. 574-578 ◽  
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 &lt; 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.

scholarly journals Clinical outcome of biportal endoscopic revisional lumbar discectomy for recurrent lumbar disc herniation

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Min-Seok Kang ◽  
Jin-Ho Hwang ◽  
Dae-Jung Choi ◽  
Hoon-Jae Chung ◽  
Jong-Hwa Lee ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Clinical Outcomes ◽  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Nerve Root ◽  
Lumbar Disc ◽  
Scar Tissue ◽  
Lumbar Discectomy ◽  
Disc Material ◽  
Recurrent Lumbar Disc Herniation

Abstract Background Although literature provides evidence regarding the superiority of surgery over conservative treatment in patients with lumbar disc herniation, recurrent lumbar disc herniation (RLDH) was the indication for reoperation in 62% of the cases. The major problem with revisional lumbar discectomy (RLD) is that the epidural scar tissue is not clearly isolated from the boundaries of the dura matter and nerve roots; therefore, unintended durotomy and nerve root injury may occur. The biportal endoscopic (BE) technique is a newly emerging minimally invasive spine surgical modality. However, clinical evidence regarding BE-RLD remains limited. We aimed to compare the clinical outcomes after performing open microscopic (OM)-RLD and BE-RLD to evaluate the feasibility of BE-RLD. Methods This retrospective study included 36 patients who were diagnosed with RLDH and underwent OM-RLD and BE-RLD. RLDH is defined as the presence of herniated disc material at the level previously operated upon in patients who have experienced a pain-free phase for more than 6 months. BE-RLD was performed as follows: two independent surgical ports were made inside the medial pedicular line of the target segment and on the intact upper and lower laminas. Peeling off the soft tissue from the vertebral lamina helps to easily identify the traversing nerve root and the recurrent disc material without dealing with the fibrotic scar tissue. Clinical outcomes were obtained using a visual analog scale (VAS) and the modified Macnab criteria before and at 2 days, 2 and 6 weeks, and 3, 6, and 12 months after surgery. Results The data of 20 and 16 patients who underwent OM-RLD and BE-RLD, respectively, were evaluated. The demographic and perioperative data were comparable between the groups. During the year following the surgery, in the BE-RLD group, the VAS scores at each point were significantly improved over the baseline and remained improved up to 2 weeks after surgery (p < 0.05); however, no statistical difference between the two groups was observed after 6 weeks of surgery (p > 0.05). According to the modified Macnab criteria on the follow-up, the excellent or good satisfaction rates reported at 2 weeks, 6 weeks, 6 months, and 12 months after surgery were 81.25%, 81.25%, 75%, and 81.25%, respectively, in the BE-RLD group, and 50%, 75%, 75%, and 80%, respectively, in the OM-RLD group. Conclusion BE-RLD yielded similar outcomes to OM-RLD, including pain improvement, functional improvement, and patient satisfaction, at 1 year after surgery. However, faster pain relief, earlier functional recovery, and better patient satisfaction were observed when applying BE-LRD. Trial registration Retrospectively registered

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