Factors Related to the Primary Discectomy in Recurrent Lumbar Disc Herniation

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Factors Related to the Primary Discectomy in Recurrent Lumbar Disc Herniation

The degree of disc removal did not influence the outcome or complication rate in Fountas et al., clinical series 1)

For Carragee et al., the more aggressive removal of remaining intervertebral disc material may decrease the risk of reherniation, but the overall outcome was less satisfactory, especially during the first year after surgery 2).

McGirt et al., found that larger annulus defects and smaller percentage of disc removed during primary surgery, rather than absolute volume as reported in previous studies, were associated with an increased risk of recurrent lumbar disc herniation while more aggressive removal contributed to accelerated disc height loss 3).

A systematic review of the literature suggests that conservative discectomy may result in shorter operative time, quicker return to work, and a decreased incidence of long-term recurrent low back pain but with an increased incidence of recurrent disc herniation. Prospective randomized trails are needed to firmly assess this possible benefit. 4).

The question remains how to balance the desire for maintaining disc height with minimizing the risk for reherniation 5).

References

 
1) 
Fountas KN, Kapsalaki EZ, Feltes CH, et al. Correlation of the amount of disc removed in a lumbar microdiscectomy with long-term outcome. Spine (Phila Pa 1976). 2004;29:2521–2526.
2) 
Carragee EJ, Spinnickie AO, Alamin TF, Paragioudakis S. A prospective controlled study of limited versus subtotal posterior discectomy: short-term outcomes in patients with herniated lumber intervertebral discs and large posterior anular defect. Spine (Phila Pa 1976). 2006;31:653–657.
3) 
McGirt MJ, Eustacchio S, Varga P, et al. A prospective cohort study of close interval computed tomography and magnetic resonance imaging after primary lumbar discectomy: factors associated with recurrent disc herniation and disc height loss. Spine (Phila Pa 1976). 2009;34:2044–2051.
4) 
Walters WC, 3rd, McGirt MJ. An evidence-based review of the literature on the consequences of conservative versus aggressive discectomy for the treatment of primary disc herniation with radiculopathy. Spine J. 2009;9:240–257.
5) 
Shepard N, Cho W. Recurrent Lumbar Disc Herniation: A Review. Global Spine J. 2019 Apr;9(2):202-209. doi: 10.1177/2192568217745063. Epub 2017 Dec 18. Review. PubMed PMID: 30984501; PubMed Central PMCID: PMC6448208.

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