Defining Recurrent Lumbar Disc Herniation (RLDH): An International Survey Study

Study DesignInternational Expert Cross-Sectional Survey.ObjectivesTo establish international expert consensus on the definition, diagnostic criteria, imaging requirements, and surgical management of recurrent lumbar disc herniation (RLDH).MethodsA comprehensive survey was developed based on current literature and disseminated globally via professional, academic, and personal networks among clinicians with expertise in spinal disorders. The survey covered core definitions, clinical symptoms, imaging criteria, and surgical preferences. Consensus was predefined as ≥70% agreement. Statistical analysis included descriptive statistics, Chi-square tests, Rasch analysis, and post-hoc analysis using adjusted standardized residuals with Bonferroni correction.ResultsA global cohort of 510 experts participated (62% neurosurgeons, 30% orthopedic surgeons), primarily from Europe (42%), North America (25%), and Asia (19%). Strong consensus was reached for defining RLDH as a new herniation at the same level (83.5%) and same side (72.4%) as the index surgery, following a pain-free interval (77.0%). No consensus was reached on interval duration. MRI confirmation was considered necessary (96.7%), with differentiation from postoperative scar tissue (87.0%). Open microdiscectomy remains the global gold standard (43%), with significant geographic (P < 0.0001) and specialty-based (P < 0.0001) variations. North Americans more often preferred tubular microdiscectomy (25%), Asians full endoscopic techniques (25%), and Europeans open microdiscectomy (56%). Neurosurgeons favored open procedures (55%), while orthopedic surgeons preferred full endoscopic approaches (29%) and fusion (21%).ConclusionsThis study establishes a foundation for an international consensus definition of RLDH as a new herniation at the same level and side as the initial herniation, with a pain-free interval and MRI confirmation differentiating from postoperative scar tissue.