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Long-term results of disc excision for recurrent lumbar disc herniation with or without posterolateral fusion
Tsai-Sheng Fu1, Po-Liang Lai, Tsung-Ting Tsai
1Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
Study Design:
A retrospective study assessing the long-term outcomes of repeat surgery for recurrent lumbar disc herniation.
Objectives:
To evaluate the results of repeat surgery for recurrent disc herniation, and compare the results of disc excision with and without posterolateral fusion.
Summary Of Background Data:
The outcomes of revision surgery varied owing to the mixed patient populations. The optimal technique for treating recurrent disc herniation is controversial.
Methods:
The sample included 41 patients who underwent disc excision with or without posterolateral fusion, with an average follow-up of 88.7 months (range, 60-134 months). Clinical symptoms were assessed based on the Japanese Orthopedic Association Back Scores. All medical and surgical records were examined and analyzed, including pain-free interval, intraoperative blood loss, length of surgery, and postsurgery hospital stay.
Results:
Clinical outcome was excellent or good in 80.5% of patients, including 78.3% of patients undergoing a discectomy alone, and 83.3% of patients with posterolateral fusion. The recovery rate was 82.2%, and the difference between the fusion and nonfusion groups was insignificant (P = 0.799). The difference in the postoperative back pain score was also insignificant (P = 0.461). These two groups were not different in terms of age, pain-free interval, and follow-up duration. Intraoperative blood loss, length of surgery, and length of hospitalization were significantly less in patients undergoing discectomy alone than in patients with fusion.
Conclusions:
Repeat surgery for recurrent sciatica is effective in cases of true recurrent disc herniation. Disc excision alone is recommended for managing recurrent disc herniation.
