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Disc herniation after lumbar fusion
Stanley D Gertzbein1, Michael R Hollopeter
1Institute for Spinal Disorders, Baylor College of Medicine, Houston, Texas, USA.
Spine
|August 27, 2002
Summary
Herniated disc after lumbar spinal fusion occurred in 1.3% of patients. This rare complication requires consideration for recurring back pain post-lumbar fusion surgery.
Area of Science:
- Spine surgery
- Neurosurgery
- Orthopedic surgery
Background:
- Lumbar spinal fusion can lead to late complications, including disc herniation above the fused segment.
- Increased stress and motion in the adjacent segment contribute to degenerative changes and predispose to herniation.
- Disc herniation above a spinal fusion has not been extensively detailed in existing literature.
Observation:
- Eight patients (1.3%) with herniated nucleus pulposus above a lumbar spinal fusion were identified over an 8-year period.
- Patients presented with recurring back pain, and diagnosis was confirmed via myelogram CT or MRI.
- Nonoperative management failed in six of the eight patients.
Findings:
- The average age of affected patients was 56.4 years.
- Surgical intervention included discectomy alone or discectomy with revision fusion.
- Four patients underwent discectomy and fusion, with an average time of 28.4 months from herniation onset to revision fusion.
Implications:
- Herniated disc above lumbar fusion is a rare but significant complication.
- Clinicians should consider this diagnosis in patients with persistent back pain after spinal fusion.
- Further research may elucidate optimal management strategies for this condition.