recurrent disc herniation
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QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Mohammed Hawary Elmor ◽  
Salah Abd Elkhalek Hemida ◽  
Omar Yousef Hammad ◽  
Hazem Ahmad Mostafa ◽  
Salah Mostafa Hamada

Abstract Background Recurrent disc herniation is the most common cause of reoperation after the primary disc surgery, The management of recurrent disc herniation remains somewhat controversial. Surgical treatment for recurrent disk herniation can be broadly categorized as revision discectomy alone or revision discectomy and fusion or percutaneous endoscopic interlaminar discectomy. Aim of the work to evaluate and compare the therapeutic effect between different modalities of treatment of the recurrent lumbar disc protrusion (RLDP) through 3 groups: (1) First group treated by conventional discectomy. (2) Second group treated by discectomy and lumbar fusion either by PLF, PLIF or TLIF. (3) Third group treated by percutaneous endoscopic interlaminar discectomy. Patients and methods It is a prospective cohort study performed between January 2012 and April 2017 on 150 patients complained of recurrent lumbar disc herniation. They were surgically treated at the Department of Neurosurgery, Ain Shams University Hospitals. All patients are evaluated clinically by VAS, JOA and Oswestry disability index (ODI) through follow up period of 2 years (one month, 6 months, 1 yr, 2 yrs). They were divided into 3 groups (I&II and III) each group was a fifty patients Results the mean overall recovery rate is 89%, comparison between the three groups showed significant improvement of the endoscopic group and fixation group than simple discectomy group in term of VAS LBP, leg pain , JOA and ODI. Intraoperative blood loss, length of operation and hospital stay were significant less in endoscopic group than fixation and simple discectomy group CONCLUSION Recurrent lumbar disc prolapse management is a controversial issue, there are different surgical modalities (either by open discectomy, discectomy and fixation or Percutaneous interlaminar lumbar discectomy PEILD) although those surgical modalities are successful the PEILD is the optional choice that offers less tissue trauma, rapid recovery, less cost effect and early return to work


2021 ◽  
Vol 18 (1) ◽  
pp. 47-52
Author(s):  
O. N. Dreval ◽  
A. V. Kuznetsov ◽  
V. A. Chekhonatsky ◽  
A. V. Baskov ◽  
A. A. Chekhonatsky ◽  
...  

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.


Vrach ◽  
2021 ◽  
Vol 32 (7) ◽  
pp. 25-31
Author(s):  
A. Yarikov ◽  
O. Perlmutter ◽  
I. Smirnov ◽  
A. Boyarshinov ◽  
A. Simonov ◽  
...  

QJM ◽  
2020 ◽  
Vol 113 (Supplement_1) ◽  
Author(s):  
I H Sabry ◽  
M S Kabil ◽  
H N Mostafa ◽  
O E Ahmed ◽  
K M M Elshafei

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.


2019 ◽  
Author(s):  
Lu Hao ◽  
Shengwen Li ◽  
Junhui Liu ◽  
Zhi Shan ◽  
Shunwu Fan ◽  
...  

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.


2019 ◽  
Vol 10 (7) ◽  
pp. 832-836 ◽  
Author(s):  
Leah Y. Carreon ◽  
Erica F. Bisson ◽  
Eric A. Potts ◽  
Morgan E. Brown ◽  
Stacie Gren ◽  
...  

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.


2019 ◽  
Vol 31 (1) ◽  
pp. 15-19
Author(s):  
Ricarda Lechner ◽  
David Putzer ◽  
Martin Krismer ◽  
Christian Haid ◽  
Alois Obwegeser ◽  
...  

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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