Postchemonucleolysis discectomy versus repeat discectomy: a prospective 1- to 13-year comparison

Area of Science:

• Neurosurgery
• Orthopedic Surgery
• Spinal Surgery

Background:

• Lumbar disc herniation is a common cause of low back pain and radiculopathy.
• Chemonucleolysis (CNL) and laminectomy are established treatments for lumbar disc herniation.
• Repeat surgery may be necessary for persistent or recurrent symptoms.

Purpose of the Study:

• To compare the long-term clinical outcomes of subsequent laminectomy after initial chemonucleolysis (CNL) versus repeat laminectomy for lumbar disc herniation.

Main Methods:

• A long-term prospective study of 103 patients with lumbar disc herniation.
• Patients underwent either chemonucleolysis followed by laminectomy (post-CNL group, n=53) or repeat laminectomy (n=50).
• Clinical assessments at 6 weeks, 6 months, and 12 months, with long-term follow-up via questionnaire (average 6.6 years for post-CNL, 5.2 years for repeat laminectomy).

Main Results:

• Long-term success rates were significantly higher for the post-CNL laminectomy group (81.8%) compared to the repeat laminectomy group (64.4%).
• In patients with initial treatment failure, the second procedure success rate was higher in the post-CNL group (72.7%) versus the repeat laminectomy group (51.1%).
• Employment rates were higher in the post-CNL group (80%) with fewer job changes (21.8%) compared to the repeat laminectomy group (76.3% employment, 48.3% job changes).

Conclusions:

• Subsequent laminectomy after chemonucleolysis yields superior long-term clinical results for lumbar disc herniation compared to repeat laminectomy.
• Chemonucleolysis followed by laminectomy may offer better functional outcomes and return to work.
• These findings support considering chemonucleolysis as an initial treatment option for selected patients with lumbar disc herniation.