Revision surgery for lumbar disc herniation. An analysis of 45 patients

We reviewed 45 patients who had undergone repeated open operations for lumbar disc herniation. There were 26 men and 19 women with a mean follow up of 4.3 years. Twenty-four patients had had one previous discectomy, 12 had 2, and 9 had 3 or more; 11 needed a fusion without instrumentation. Residual or re-extruded disc hernias, either sub- or transligamentous, were frequently found at revision. Good to excellent results were obtained in 64%. Those who had a first-time revision had earlier improvement and better results. Complete removal and a thorough search for herniated disc material is essential when carrying out the initial operation for extruded or sequestrated herniation. At revision, removal of as much as possible of the remaining nucleus and annulus, but with minimal invasion of the posterior elements, is crucial for improving the outcome.