Revision after failed discectomy

Area of Science:

• Neurosurgery
• Orthopedic Surgery
• Spinal Surgery

Background:

• Recurrent lumbar disc herniation is a common complication post-discectomy.
• Altered anatomy and scar tissue make surgical revision challenging.

Purpose of the Study:

• To describe the microsurgical revision technique for recurrent lumbar disc herniation.
• To evaluate clinical outcomes of revision surgery compared to primary lumbar disc surgery.

Main Methods:

• Retrospective analysis of clinical data from 2576 primary discectomies (PD) and 592 revision discectomies (RD).
• Evaluation of 894 PD and 117 RD cases with 12- and 24-month follow-up.
• Recording of intraoperative dura lesion rates between 2016-2018.

Main Results:

• Both PD and RD groups showed significant improvement in Oswestry Disability Index (ODI) and Visual Analog Scale (VAS) for pain.
• ODI improved to 12.6 (PD) and 22.9 (RD) at 24 months.
• VAS scores for back and leg pain decreased significantly in both groups, with slightly better outcomes in the PD group.

Conclusions:

• No clear guidelines exist for recurrent disc herniation surgery.
• Microsurgical re-discectomy is often sufficient, safe, and effective.
• Revision surgery yields good results, albeit slightly inferior to primary procedures.