Revision Surgery for "Real" Recurrent Lumbar Disk Herniation: A Systematic Review

Area of Science:

• Neurosurgery
• Orthopedic Surgery
• Spinal Surgery

Background:

• Recurrent lumbar disk herniation (RLDH) involves herniated disk material at the same spinal level and side as the initial herniation.
• Revision surgery is a significant consideration when conservative treatments fail for RLDH.
• Understanding the epidemiology and outcomes of revision surgery for RLDH is vital for patients and surgeons.

Purpose of the Study:

• To systematically review the existing literature on revision surgery for true recurrent lumbar disk herniation (real-RLDH).
• To summarize trends in incidence, risk factors, surgical approaches, complications, and clinical outcomes associated with real-RLDH revision surgery.

Main Methods:

• A systematic review of English-language articles published between January 1980 and May 2014.
• Searches were conducted in major electronic databases: PubMed, Cochrane Library, and EMBASE.
• Data extracted included incidence, time intervals, risk factors, surgical types, complications, and clinical outcomes.

Main Results:

• The incidence of revision surgery for real-RLDH ranges from 1.4% to 11.4%.
• Complication rates vary between 0% and 34.6%, with dural tear being the most frequent complication.
• Satisfactory clinical outcomes (60%-100%) were reported, with some studies indicating outcomes similar to primary discectomy.

Conclusions:

• Revision surgery for real-RLDH occurs at a relatively low frequency.
• Preventing dural tears requires careful surgical technique during revision procedures.
• Patients undergoing revision surgery for real-RLDH can anticipate clinical results comparable to those of primary discectomy.