scholarly journals Pathogenetic aspects and risk factors for recurrent lumbar disc herniation: literature review

2021 ◽  
Vol 18 (1) ◽  
pp. 47-52
Author(s):  
O. N. Dreval ◽  
A. V. Kuznetsov ◽  
V. A. Chekhonatsky ◽  
A. V. Baskov ◽  
A. A. Chekhonatsky ◽  
...  
Keyword(s):  
Risk Factors ◽  
Disc Herniation ◽  
Lumbar Disc ◽  
Spinal Column ◽  
Pain Syndrome ◽  
Herniated Disc ◽  
Scientific Publications ◽  
Recurrent Disc Herniation ◽  
Herniated Discs ◽  
Recurrent Lumbar Disc Herniation

One of the main causes of the development of debilitating pain syndrome after surgical treatment of a herniated disc is herniation recurrence. This pathology dictates the need to perform reoperation on an already operated segment of the spinal column, which complicates the technique of surgical intervention and negatively affects the relief of pain syndrome. In the presented review of scientific publications selected from the medical literature databases PubMed, E-library and Cochrane, the current problems of the pathogenesis of recurrent herniated discs in the lumbar spine are considered. The concept of risk factors for the development of recurrent disc herniation is highlighted, their characteristics are given, and the significance of each of them in the development of recurrent disc herniation is analyzed.

Risk factors for recurrent lumbar disc herniation after discectomy

2018 ◽  
Vol 43 (4) ◽  
pp. 963-967 ◽  
Author(s):  
Eun-Ho Shin ◽  
Kyu-Jung Cho ◽  
Young-Tae Kim ◽  
Myung-Hoon Park
Keyword(s):  
Risk Factors ◽  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Lumbar Disc ◽  
Recurrent Lumbar Disc Herniation

scholarly journals Risk Factors for Early Recurrence After Transforaminal Endoscopic Lumbar Disc Decompression

2019 ◽  
Vol 2 (22.2) ◽  
pp. E133-E138
Author(s):  
Chan Hong Park
Keyword(s):  
Risk Factors ◽  
Disc Herniation ◽  
Smoking Status ◽  
Lumbar Disc ◽  
Early Recurrence ◽  
Herniated Disc ◽  
Endoscopic Recurrence ◽  
Imaging Results ◽  
Key Words Disc Herniation ◽  
A Prospective Study

Background: Transforaminal endoscopic lumbar disc decompression (TELD) has emerged as a treatment alternative to open lumbar discectomy, but rates of herniated lumbar disc (HLD) recurrence after TELD are higher by comparison. Objectives: We conducted this study to identify factors correlating with early HLD recurrence after TELD. Study Design: Retrospective study. Setting: The Department of Anesthesiology and Pain Medicine, Neurosurgery at Spine Health Wooridul Hospital. Methods: As a retrospective review, we examined all patients undergoing TELD between 2012 and 2017, analyzing the following in terms of time to recurrence: age, gender, body mass index (BMI), comorbid conditions (diabetes mellitus [DM], hypertension [HTN]), smoking status, nature of disc herniation (central, paramedian, or foraminal), Modic changes, migration grade (rostral vs. caudal track + degree), herniated disc height (Dht) and base size (Dbase), and the presence of spondylolisthesis on magnetic resonance imaging. Results: During the 5-year study period, 1,900 patients underwent TELD procedures, resulting in 209 recurrences (11.0%). In 27 of these patients (12.9%), herniation recurred within 24 hours after surgery. Recurrences most often developed within 2-30 days (n = 76). The smaller the size of a herniated disc, the earlier it recurred. Recurrences were unrelated to gender, BMI, DM or HTN, smoking status, migration grade, nature (Dht or Dbase of herniated disc), or the presence of spondylolisthesis. Limitations: In addition to variables assessed herein, other clinical and radiologic parameters that may be important in recurrent disc herniation should be included. Furthermore, only univariate analyses were performed, making no adjustments for potential confounders, therefore, independent risk factors could not be assessed. A prospective study would likely generate more precise results, especially in terms of standardized sampling and data classification. Finally, multiple causes for primary discectomy failures may have rendered our patient groups nonhomogeneous, and inequalities in surgical options or physician-dictated surgical choices may have had an effect. Conclusions: In patients undergoing TELD procedures, smaller-sized herniated discs are linked to early recurrences. Key words: Disc herniation, lumbar, endoscopic, recurrence, early

scholarly journals Recurrent Lumbar Disc Herniation: A Review

2017 ◽  
Vol 9 (2) ◽  
pp. 202-209 ◽  
Author(s):  
Nicholas Shepard ◽  
Woojin Cho
Keyword(s):  
Risk Factors ◽  
Surgical Management ◽  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Lumbar Disc ◽  
Cochrane Library ◽  
Disc Disease ◽  
Disc Herniations ◽  
Invasive Techniques ◽  
Recurrent Lumbar Disc Herniation

Study Design: Narrative review. Objectives: To identify the risk factors and surgical management for recurrent lumbar disc herniation using a systematic review of available evidence. Methods: We conducted a review of PubMed, MEDLINE, OVID, and Cochrane Library databases using search terms identifying recurrent lumbar disc herniation and risk factors or surgical management. Abstracts of all identified articles were reviewed. Detailed information from articles with levels I to IV evidence was extracted and synthesized. Results: There is intermediate levels III to IV evidence detailing perioperative risk factors and the optimal surgical technique for recurrent lumbar disc herniations. Conclusions: Multiple risk factors including smoking, diabetes mellitus, obesity, intraoperative technique, and biomechanical factors may contribute to the development of recurrent disc disease. There is widespread variation regarding optimal surgical management for recurrent herniation, which often include revision discectomies with or without fusion via open and minimally invasive techniques.

scholarly journals Risk Factors for Recurrent Lumbar Disc Herniation

Medicine ◽  
2016 ◽  
Vol 95 (2) ◽  
pp. e2378 ◽  
Author(s):  
Weimin Huang ◽  
Zhiwei Han ◽  
Jiang Liu ◽  
Lili Yu ◽  
Xiuchun Yu
Keyword(s):  
Risk Factors ◽  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Lumbar Disc ◽  
Recurrent Lumbar Disc Herniation

scholarly journals Fully Endoscopic Transforaminal Lumbar Discectomy for Upward Migration of Upper Lumbar Disc Herniation: Clinical and Radiological Outcomes and Technical Considerations

2020 ◽  
Vol 10 (6) ◽  
pp. 363
Author(s):  
Dong Hwa Heo ◽  
Dong Keun Lee ◽  
Dong Chan Lee ◽  
Hyeun Sung Kim ◽  
Choon Keun Park
Keyword(s):  
Disc Herniation ◽  
Facet Joint ◽  
Lumbar Disc ◽  
Early Recurrence ◽  
Lumbar Discectomy ◽  
Herniated Disc ◽  
Upward Migration ◽  
Postoperative Mri ◽  
Alternative Treatment Option ◽  
Herniated Discs

Microdiscectomy for the upward migration of upper lumbar herniated discs has a high risk of isthmus and facet injury. Fully endoscopic transforaminal discectomy can preserve normal bony structures during discectomy. The purpose of this study was to assess the clinical and radiological outcomes of fully endoscopic transforaminal discectomy for upward migrated upper lumbar herniated discs. All patients had upward migrated disc herniation from L1–L2 to L3–L4 levels and were treated using fully endoscopic transforaminal discectomy under local anesthesia. All enrolled patients were monitored for more than 12 months. Clinical outcomes were assessed using the Oswestry Disability Index (ODI) and visual analog scale (VAS) of pain. Surgery-related complications were analyzed. In addition, radiological outcomes were investigated using postoperative magnetic resonance imaging (MRI) and lumbar dynamic X-ray. Twenty-eight patients were enrolled in this study. ODI and VAS significantly decreased after endoscopic transforaminal discectomy. Migrated ruptured disc particles were completely removed and confirmed on postoperative MRI in 26 of the 28 patients. Even though small remnant disc particles were detected in two patients, symptoms improved after endoscopic transforaminal discectomy. Early recurrence of herniated disc occurred at the operated segment in one patient. There were no significant complications associated with fully endoscopic transforaminal discectomy. Three patients experienced a postoperative transient tingling sensation and numbness of the leg. Fully endoscopic transforaminal lumbar discectomy may be an effective and alternative treatment option for upward migrated disc herniation in the upper lumbar area. In addition, fully endoscopic transforaminal lumbar discectomy may prevent complications associated with general endotracheal anesthesia and injuries of the isthmus and the facet joint.

scholarly journals Recurrent Lumbar Disc Herniation: A Narrative Review

2020 ◽  
Vol 1 (1) ◽  
Keyword(s):  
Risk Factors ◽  
Operative Treatment ◽  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Lumbar Disc ◽  
Narrative Review ◽  
Leg Pain ◽  
Epidural Fibrosis ◽  
Fusion Procedure ◽  
Recurrent Lumbar Disc Herniation

This narrative review aimed to identify various risk factors of recurrent lumbar disc herniation (rLDH) post-discectomy and its management. The rLDH has remained a challenging problem for spine surgeons. The incidence of rLDH is reported widely from 1% to 21%. Many possible patient-related, disc-related, and surgery-related risk factors may predispose the patient to rLDH. Moreover, the clinical and radiological diagnosis of rLDH can be challenging. Once the diagnosis is confirmed, and alternative diagnoses for leg pain have been ruled out, a course of initial non-operative treatment can be attempted. Compared to primary LDH, non-operative treatment is less likely to succeed in rLDH, possibly due to the associated epidural fibrosis and scarring. Various surgical options can be considered, including revision discectomy and fusion. Revision discectomy is usually the primary choice of surgery for the first recurrence. A fusion procedure can be chosen for those who have repeated reherniations or significant associated back pain. Precise patient selection is a must to achieve excellent surgical outcomes. Keywords: Lumbar disc herniation, recurrent herniation, discectomy, risk factor, Epidural fibrosis, narrative review.

scholarly journals Stand-Alone Open Disectomy versus Fixation in Management of Recurrent Lumbar Disc Prolapse

QJM ◽  
2020 ◽  
Vol 113 (Supplement_1) ◽  
Author(s):  
I H Sabry ◽  
M S Kabil ◽  
H N Mostafa ◽  
O E Ahmed ◽  
K M M Elshafei
Keyword(s):  
Systematic Review ◽  
Disc Herniation ◽  
Lumbar Disc ◽  
Recurrent Disc Herniation ◽  
Significant Difference ◽  
Repeated Surgery ◽  
Dural Tears ◽  
Reoperation Rates ◽  
Recurrent Lumbar Disc Herniation

Abstract Background The strict definition of recurrent disc herniation is the presence of herniated disc material at the same level, ipsi- or contralateral, in a patient who had experienced a pain-free interval of at least 6 months following discectomy. Objective The main objective of the systematic review was to compare the outcome of repeated surgery after these two techniques. Methods In the present systematic review, we evaluated 655 patients from 9 studies undergoing surgery for RLDH. Both procedures stand-alone open discectomy and discectomy with fusion were found to cause significant improvement in symptoms and disability following revision of different surgical techniques used in the primary surgery. These were open surgery. All patients showed no improvement or unsatisfactory outcome after a variable periods of proper conservative treatment. Results From the results of this systematic review concerning the recurrent lumbar disc: Recurrent lumbar disc herniation was common in males due to higher physical stress and activity. Both procedures were found to cause significant improvement in symptoms and disability following revision surgery. Fusion was found to be associated with longer operative time (70 min on average), higher intraoperative EBL (220 ml on average) and delayed hospital discharge (an average of 3 days). No significant differences were found with regards to functional outcomes, reoperation rates and dural tears between the two cohorts. Repeat discectomy alone may cause or exacerbate lumbar instability. Sciatica was the first presenting symptoms in all cases while back pain was present significantly more in patient done discectomy alone. There was no significant difference between the two approaches regarding the sensory deficit or muscle weakness. Treatment options for recurrent disc herniation include observation and aggressive medical management or operative intervention, in this systematic review all patients were managed surgically, after failure of conservative management. The optimal surgical approach for recurrent disc herniation remains a subject of controversy. Discectomy with fusion has several theoretical advantages. Dural tear was the main immediate intraoperative complication. The surgical treatment was successful with excellent or good outcome in the majority of cases with no significant difference between the two approaches and it is widely accepted that the results after repeated surgery are comparable to those of the first surgery. There was no significant factor influencing the outcome of surgery including age, sex, diabetes, duration of symptoms or pain-free interval and level or side of recurrence. Conclusion Surgery for recurrent lumbar disc herniation can be very successful and may approach the success rate for initial operations provided proper patient selection, good and thorough examination and investigations and proper surgical technique. Available evidence shows that in treating recurrent lumbar discs herniation, repeat discectomy and fusion are associated with comparable reoperation rates, incidence of dural tears, functional outcomes as well as satisfaction with surgical treatment at last follow-up. The findings should be viewed within the context of variable length of follow-up in the included studies; as such, the true long term implications of fusion as compared to repeat discectomy remain to be elucidated. Longitudinal randomized controlled trials are needed to provide firm evidence in this field.

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 < 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.

Braking reaction time before and after surgery for patients with recurrent lumbar disc herniation

2019 ◽  
Vol 31 (1) ◽  
pp. 15-19
Author(s):  
Ricarda Lechner ◽  
David Putzer ◽  
Martin Krismer ◽  
Christian Haid ◽  
Alois Obwegeser ◽  
...  
Keyword(s):  
Reaction Time ◽  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Positive Impact ◽  
Lumbar Disc ◽  
Control Group ◽  
Recurrent Disc Herniation ◽  
Before And After ◽  
Recurrent Lumbar Disc Herniation

OBJECTIVEThe positive effect of primary lumbar disc surgery on braking reaction time (BRT) has already been shown. The authors investigated the effect of recurrent lumbar disc herniation surgery on BRT.METHODSTwenty-four patients (mean age 49.9 years) were investigated for BRT 1 day before surgery, postoperatively before hospital discharge, and 4 to 5 weeks after surgery. Thirty-one healthy subjects served as a control group.RESULTSSignificant improvement of BRT following surgery was found in all patients (p < 0.05). For patients with right-sided recurrent disc herniation, median BRT was 736 msec before surgery, 685 msec immediately postoperatively, and 662 msec at follow-up. For patients with left-sided recurrent disc herniation, median BRT was 674 msec preoperatively, 585 msec postoperatively, and 578 msec at follow-up. Control subjects had a median BRT of 487, which differed significantly from the patient BRTs at all 3 test times (p < 0.05).CONCLUSIONSA significant reduction in BRT in patients with recurrent disc herniation was found following lumbar disc revision surgery, indicating a positive impact of surgery. Due to the improvement in BRT observed immediately after surgery, we conclude that it is appropriate to recommend that patients keep driving after being discharged from the hospital.

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