Letter to the Editor. Recurrent disc herniation and spinal instability

Study Design: Longitudinal cohort. Objective: It is unclear if patients with a recurrent disc herniation benefit from a concurrent fusion compared with a repeat decompression alone. We compared outcomes of decompression alone (D0) versus decompression and fusion (DF) for recurrent disc herniation. Methods: Patients enrolled in the Quality and Outcomes Database from 3 sites with a first episode of recurrent disc herniation were identified. Demographic, surgical, and radiographic data including the presence of listhesis and extent of facet resection on computed tomography or magnetic resonance imaging prior to the index surgery were collected. Patient-reported outcomes were collected preoperatively and at 3 and 12 months postoperatively. Results: Of 94 cases identified, 55 had D0 and 39 had DF. Patients were similar in age, sex distribution, smoking status, body mass index, American Society of Anesthesiologists grade and surgical levels. Presence of listhesis (D0 = 7, DF = 5, P = .800) and extent of facet resection (D0 = 19%, DF = 16%, P = .309) prior to index surgery were similar between the 2 groups. Estimated blood loss (D0 = 26 cm3, DF = 329 cm3, P < .001), operating room time (D0 = 79 minutes, DF = 241 minutes, P < .001) and length of stay (D0 <1 day, DF = 4 days, P < .001) were significantly less in the D0 group. Preoperative and 1-year postoperative patient-reported outcomes were similar in both groups. Three patients in the D0 group and 2 patients in the DF group required revision. Regression analysis showed that presence of listhesis, extent of facet resection and fusion were not associated with the 12-month Oswestry Disability Index (ODI) score. Conclusion: For a first episode recurrent disc herniation, surgeons can expect similar outcomes whether patients are treated with decompression alone or decompression and fusion.

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Letter to the editor regarding “Comparison of percutaneous endoscopic lumbar discectomy versus microendoscopic discectomy for the treatment of lumbar disc herniation: a meta-analysis”

International Orthopaedics ◽

10.1007/s00264-019-04421-y ◽

2019 ◽

Vol 44 (5) ◽

pp. 1015-1016

Author(s):

Xiaoping Mu ◽

Yufu Ou ◽

Bo Hou ◽

Zhian He

Keyword(s):

Lumbar Disc Herniation ◽

Disc Herniation ◽

Lumbar Disc ◽

Meta Analysis ◽

Lumbar Discectomy ◽

Percutaneous Endoscopic Lumbar Discectomy ◽

Letter To The Editor ◽

Microendoscopic Discectomy ◽

Endoscopic Lumbar Discectomy

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Unilateral facetectomy approach for lateral lumbar disc herniation

Journal of Neurosurgery ◽

10.3171/jns.1991.74.5.0754 ◽

1991 ◽

Vol 74 (5) ◽

pp. 754-756 ◽

Cited By ~ 75

Author(s):

Eddy Garrido ◽

P. Noel Connaughton

Keyword(s):

Disc Herniation ◽

Lumbar Fusion ◽

Lumbar Disc ◽

Herniated Disc ◽

Spinal Instability ◽

Content Type ◽

X Ray ◽

Flexion And Extension ◽

Fine Print

✓ Forty-one patients with herniated lumbar discs in a lateral location underwent unilateral complete facetectomy for removal of their disc herniation. The diagnosis was made by computerized tomography in all patients. The follow-up period varied between 4 and 60 months, with an average of 22.4 months. All patients underwent dynamic lumbar spine x-ray films with flexion and extension exposures at various times during their follow-up period. The results were excellent in 35 patients, good in three, and poor in three. One patient suffered spinal instability postoperatively and required lumbar fusion because of back pain. Unilateral facetectomy gives an excellent view of the affected nerve root and the herniated disc, and the risk of spinal instability is very low.

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Same-level Recurrent Disc Herniation after Lumbar Discectomy: Results of a Prospective Cohort Study with 2-Year Serial Imaging

The Spine Journal ◽

10.1016/j.spinee.2010.07.176 ◽

2010 ◽

Vol 10 (9) ◽

pp. S65

Author(s):

Richard L. Lebow ◽

Owoicho Adogwa ◽

Scott L. Parker ◽

Adrija Sharma ◽

Joseph Cheng ◽

...

Keyword(s):

Cohort Study ◽

Prospective Cohort Study ◽

Disc Herniation ◽

Prospective Cohort ◽

Lumbar Discectomy ◽

Serial Imaging ◽

Recurrent Disc Herniation

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Minimum Two-Year Follow-Up of Cases with Recurrent Disc Herniation Treated with Microdiscectomy and Posterior Dynamic Transpedicular Stabilisation

The Open Orthopaedics Journal ◽

10.2174/1874325001004010120 ◽

2010 ◽

Vol 4 (1) ◽

pp. 120-125 ◽

Cited By ~ 10

Author(s):

Tuncay Kaner ◽

Mehdi Sasani ◽

Tunc Oktenoglu ◽

Ahmet Levent Aydin ◽

Ali Fahir Ozer

Keyword(s):

Disc Herniation ◽

Clinical Results ◽

Prospective Clinical Study ◽

Low Back ◽

Failed Back Syndrome ◽

Recurrent Disc Herniation ◽

Rod System ◽

Disc Herniations ◽

Vas Scores

The objective of this article is to evaluate two-year clinical and radiological follow-up results for patients who were treated with microdiscectomy and posterior dynamic transpedicular stabilisation (PDTS) due to recurrent disc herniation. This article is a prospective clinical study. We conducted microdiscectomy and PDTS (using a cosmic dynamic screw-rod system) in 40 cases (23 males, 17 females) with a diagnosis of recurrent disc herniation. Mean age of included patients was 48.92 ± 12.18 years (range: 21-73 years). Patients were clinically and radiologically evaluated for follow-up for at least two years. Patients’ postoperative clinical results and radiological outcomes were evaluated during the 3rd, 12th, and 24th months after surgery. Forty patients who underwent microdiscectomy and PDTS were followed for a mean of 41 months (range: 24-63 months). Both the Oswestry and VAS scores showed significant improvements two years postoperatively in comparison to preoperative scores (p<0.01). There were no significant differences between any of the three measured radiological parameters (α, LL, IVS) after two years of follow-up (p > 0.05). New recurrent disc herniations were not observed during follow-up in any of the patients. We observed complications in two patients. Performing microdiscectomy and PDTS after recurrent disc herniation can decrease the risk of postoperative segmental instability. This approach reduces the frequency of failed back syndrome with low back pain and sciatica.

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