Posterior Dynamic Stabilization with Limited Rediscectomy for Recurrent Lumbar Disc Herniation

Area of Science:

• Neurosurgery
• Orthopedic Surgery
• Spinal Surgery

Background:

• Recurrent lumbar disc herniation (RLDH) is a common complication after primary discectomy, often causing significant sciatica.
• Effective treatment strategies for RLDH are crucial to improve patient outcomes and reduce reoperation rates.

Purpose of the Study:

• To evaluate the efficacy of transpedicular dynamic stabilization (TDS) combined with limited rediscectomy for treating single-level RLDH.
• To assess the impact of TDS on pain, function, spinal motion, and disc height in patients with RLDH.

Main Methods:

• Retrospective evaluation of 24 middle-aged patients with Carragee type II and IV RLDH treated with TDS (Dynesys system) and limited rediscectomy.
• Clinical outcomes assessed using Visual Analog Scale (VAS) for pain and Oswestry Disability Index (ODI) scores.
• Imaging analysis included lumbar segment range of motion (ROM) and intervertebral height.

Main Results:

• Significant improvements in VAS and ODI scores were observed at a mean follow-up of 38 months.
• Mean ROM preservation of 78.6% was achieved at the stabilized segment, with a slight, stable decrease in intervertebral height.
• No cases of reherniation, screw loosening, or segmental instability were reported.

Conclusions:

• Transpedicular dynamic stabilization with limited rediscectomy is an effective treatment for single-level RLDH in middle-aged patients.
• The procedure successfully stabilizes the affected segment while preserving partial motion and maintaining disc height.
• This combined approach may decrease the risk of recurrence, particularly in patients with large posterior annular defects.