Patients at the Highest Risk for Reherniation Following Lumbar Discectomy in a Multicenter Randomized Controlled...

Area of Science:

• Neurosurgery
• Orthopedic Surgery
• Spinal Surgery

Background:

• Recurrent lumbar disc herniation poses a significant challenge after surgical treatment.
• Large anular defects following limited discectomy are associated with increased reherniation risk.

Purpose of the Study:

• To confirm the risk of recurrent lumbar disc herniation in patients with large anular defects after limited discectomy.
• To identify potential risk factors for recurrent lumbar disc herniation in this specific patient group.

Main Methods:

• Analysis of a control cohort from a prospective, randomized trial of patients with large anular defects (6-10 mm wide).
• Inclusion of 278 patients undergoing limited discectomy for lumbar disc herniation.
• Multivariate logistic regression analysis of demographic and surgical variables over a 24-month follow-up.

Main Results:

• A 25.3% incidence of symptomatic recurrent lumbar disc herniation was observed at 2 years.
• Increased risk associated with female sex (OR, 2.2) and larger anular defect widths (OR, 1.3).
• Significant interaction between age and sex (p = 0.005) identified, with females ≤50 years having the highest risk.

Conclusions:

• Substantial evidence confirms a high reherniation risk in patients with large anular defects.
• Females ≤50 years with large anular defects face up to ~10 times higher risk of recurrent lumbar disc herniation.
• Anular repair or closure is recommended after limited discectomies in patients with large anular defects.