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The long-term outcome of revision microdiscectomy for recurrent sciatica
M B Lequin1,2,3, D Verbaan4,5, P R Schuurman4,5
1Department of Neurosurgery, Amsterdam University Medical Centers Location Acadamic Medical Center, Neurosurgery, Meibergdreef 9, 1105 EZ, Amsterdam, The Netherlands. m.b.lequin@amsterdamumc.nl.
Summary
Revision microdiscectomy for lumbosacral radicular syndrome (LSRS) yields unfavorable long-term outcomes for most patients, with a high re-operation rate. Despite this, it remains a viable treatment option for recurrent LSRS.
Area of Science:
- Neurosurgery
- Spinal Surgery
- Orthopedics
Background:
- Lumbosacral radicular syndrome (LSRS) often necessitates surgical intervention.
- Microdiscectomy is a common primary treatment, but recurrence or persistent symptoms may require revision surgery.
Purpose of the Study:
- To evaluate the long-term outcomes of revision microdiscectomy in patients with lumbosacral radicular syndrome (LSRS) previously treated with classic microdiscectomy.
- To assess the rate of further re-operation and patient-reported outcomes after revision surgery.
Main Methods:
- A cohort study of 88 patients who underwent revision microdiscectomy for MRI-confirmed disc-related LSRS between 2007-2010.
- Patients completed validated questionnaires assessing pain (VAS), functional status (RDQ, OLBD), and overall recovery (RAND-36, Likert scales).
- Data on subsequent re-revision surgeries were collected and analyzed.
Main Results:
- After a median follow-up of 10 years, only 40-45% of patients reported favorable general recovery, leg pain, or back pain outcomes.
- Patients with unfavorable outcomes reported significantly higher leg and back pain scores (VAS).
- Re-revision surgery was performed in 35% of patients, with no significant difference in outcomes based on re-operation status.
Conclusions:
- Revision microdiscectomy for LSRS is associated with a majority of unfavorable long-term outcomes and a high rate of re-revision surgery.
- Despite disappointing results, revision microdiscectomy may still be considered a valid treatment for recurrent LSRS, especially given limited alternatives.
- These findings are crucial for patient counseling regarding treatment choices and expectations.
