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Microsurgery for recurrent lumbar disk herniation at the same level and side: do patients fare worse? Experience with
Lucio Palma1, Biagio Carangelo, Vitaliano F Muzii
1Department of Ophthalmological and Neurosurgical Sciences, Neurosurgical Clinic, Siena University Medical School, 53100 Siena, Italy. palma@unisi.it
Background:
In reviewing our experience with reoperation of RLDH, our aim was mainly to determine whether patients fared worse than after primary surgery. We found no uniform answers to this question in the literature.
Methods:
The data of 95 patients (29 women and 66 men) who underwent reoperation for RLDH at the same level and side were analyzed retrospectively. Forty-two patients underwent the first operation in our clinic (recurrence rate, 2.6% of 1586 cases). Gadolinium-enhanced MRI was performed in all patients. Main clinical data of patients, pain-free interval, operation time, surgical complications, duration of hospital stay, and clinical improvement rate were recorded.
Results:
The mean pain-free interval was 55 months (range, 3-120 months). Levels of recurrent herniation were L4 through L5 and L5 through S1 (65% and 35% of cases, respectively). Revision surgery lasted longer on average than the previous diskectomy (P < .01) and was complicated by dural tear in 4 cases (4.2% vs 0.9% during primary diskectomy, P < .05). There were no significant differences between revision and previous surgery in terms of hospital stay. However, rates of excellent/good outcomes were significantly less for RLDH (89% vs 95%, P < .05); and the percentage of poor results was higher (2% vs 0.5%, P < .05). Age, sex, smoking, profession, trauma, level and degree of herniation, and pain-free interval were not correlated with clinical outcome.
Conclusion:
Conventional microsurgery for RLDH showed lightly but significantly worse results than those of primary microdiskectomy. Patients contemplating reoperation should be informed of this fact and of the risk of dural tear and prolonged operation time.
Insights
Reoperation for recurrent lumbar disc herniation (RLDH) yields slightly worse outcomes than primary surgery. Patients should be aware of increased risks, including dural tear and longer operation times.
Area of Science:
- Neurosurgery
- Spinal Surgery
- Orthopedic Surgery
Background:
- Reoperation for recurrent lumbar disc herniation (RLDH) outcomes compared to primary surgery are not well-defined.
- This study reviews experience with RLDH reoperation to assess patient outcomes relative to primary surgery.
Purpose of the Study:
- To determine if patients fare worse after reoperation for RLDH compared to primary microdiskectomy.
- To identify factors influencing outcomes in RLDH reoperation.
Main Methods:
- Retrospective analysis of 95 patients undergoing reoperation for RLDH at the same spinal level and side.
- Data collected included pain-free interval, operation time, complications, hospital stay, and clinical improvement.
- Gadolinium-enhanced MRI was performed on all patients.
Main Results:
- Revision surgery had a significantly longer operation time (P < .01) and a higher rate of dural tear (4.2% vs 0.9%, P < .05).
- Excellent/good outcomes were significantly lower for RLDH (89% vs 95%, P < .05), with a higher percentage of poor results (2% vs 0.5%, P < .05).
- No correlation was found between clinical outcome and age, sex, smoking, profession, trauma, herniation level/degree, or pain-free interval.
Conclusions:
- Conventional microsurgery for RLDH results in slightly, but significantly, worse outcomes than primary microdiskectomy.
- Patients considering RLDH reoperation must be informed about the increased risks, including prolonged operation time and potential dural tear.
