Can You Get a Hernia Disc Again After Surgery
Cureus. 2016 May; 8(v): e622.
Treatment of Recurrent Disc Herniation: A Systematic Review
Monitoring Editor: Alexander Muacevic and John R Adler
Doniel Drazin
1 Section of Neurosurgery, Cedars-Sinai Medical Eye
Beatrice Ugiliweneza
2 Department of Neurosurgery, University of Louisville
Lutfi Al-Khouja
one Section of Neurosurgery, Cedars-Sinai Medical Center
Dongyan Yang
three Section of Epidemiology and Population Health, University of Louisville
Patrick Johnson
1 Section of Neurosurgery, Cedars-Sinai Medical Center
Terrence Kim
iv Deparment of Orthopedics, Cedars-Sinai Medical Heart
Maxwell Boakye
ii Department of Neurosurgery, University of Louisville
Received 2015 Sep 24; Accepted 2016 May 21.
Abstract
Intervertebral disc herniation is ane of the almost common causes of back and extremity pain. The most ordinarily used surgical treatment is lumbar discectomy. About 0.5-25% go on to develop recurrent disc herniation (rDH) later a successful first discectomy. Currently, in that location aren't any guidelines to assistance surgeons in determining which arroyo is most appropriate to treat rDH. A contempo survey showed significant heterogeneity amongst surgeons regarding treatment options for rDH. Information technology remains unclear which methods lead to meliorate outcomes, equally there are no comparative studies with a sufficient level of evidence. In this study, we aimed to perform a systematic review to compare treatment options for rDH and determine if 1 intervention provides ameliorate outcomes than the other; more specifically, whether outcome differences be between discectomy lone and discectomy with fusion.
We applied the PICOS (participants, intervention, comparison, outcome, written report pattern) format to develop this systematic review through PubMed. Twenty-vii papers from 1978-2014 met our inclusion criteria and were included in the analysis. 9 papers reported outcomes after discectomy and seven of them showed proficient or excellent outcomes (seventy.60%-89%). Ten papers reported on minimally invasive discectomy. The percent alter in visual analog scale (VAS) ranged from -fifty.77% to -86.57%, indicating an overall pain reduction. Four studies out of the ten reported expert or fantabulous outcomes (81% to 90.2%). 3 studies looked at posterolateral fusion. Three studies analyzed posterior lumbar interbody fusion. For one written report, we institute the VAS percentage change to be -46.02%. All reported good to excellent outcomes. Half dozen studies evaluated the transforaminal lumbar interbody fusion. All reported comeback in pain. Four used VAS, and nosotros plant the percent alter to exist -54% to -86.5%. The other ii used the Japanese Orthopedic Clan (JOA) score, and we plant the percent change to be 68.3% to 93.3%.
We did non find enough bear witness to support whatever significant deviation in outcomes between discectomy alone and discectomy with fusion. The limitation of our study includes the lack of standardized outcomes reporting in the literature. However, reviewing the selected articles shows that fusion may take a greater improvement in hurting compared to reoperation without fusion. Nevertheless, our study shows that further and more in-depth investigation is needed on the of handling of rDH.
Keywords: recurrent disc herniation, recurrent lumbar disc herniation, spine, spinal fusion, revision fusion, minimally invasive lumbar fusion, interbody fusion, back pain
Introduction
Intervertebral disc herniation is one of the almost mutual causes of dorsum and extremity hurting that tin eventually require surgical intervention. Many surgical approaches have been utilized to treat disc herniation where the type of surgery is dependent upon the level of herniation, type of herniation, symptomatology, and surgeon preference. The most commonly used surgical method is a lumbar discectomy [1].
Disc reherniation is the most mutual cause of reoperation subsequently master disc surgery and is divers as disc herniation occurring at the same level in a patient after a definite pain-free catamenia of at to the lowest degree six months from initial surgery [2]. Rates of recurrent disc herniation (rDH) take been reported to exist between 0.v% and 25% [3]. Although there are many theories as to what increases a patient'south run a risk for reherniation, no one factor has been identified consistently in the literature. Some of these proposed risk factors include obesity, smoking, male person gender, diabetes, weightlifting, the size of the annular tear, and type of primary operation [4-17]. Other causes of reoperation include new disc herniation at a dissimilar level, epidural fibrosis, adhesive arachnoiditis, spinal stenosis, and segmental instability [18].
Currently, there are no guidelines or meaning comparative studies to help surgeons in determining which arroyo would exist most appropriate to care for rDH. The American Association of Neurologic Surgeons (AANS) 2014 guidelines report low-level evidence to support fusion for rDH and call for further investigations with improved report designs to better address this issue [19]. In the absence of guidelines to arroyo patients with rDH, in that location are pregnant differences in treatment plans among spine surgeons in the United states, which was evaluated in a survey of spine surgeons past Mroz, et al. [20]. Their survey found that a patient's treatment plan varied based on surgeon feel and operative volume. With the prognosis of repeated back surgery existence relatively poor in regards to pain relief and return to piece of work [21], identifying the advisable treatment for recurrent disc herniation is important to meliorate prognosis. A recent recommendation by Wang, et al. is to perform a discectomy in patients with rDH and radiculopathy [nineteen]. Fu, et al. reported similar recommendations. Additionally, fusion has been recommended if the patient has associated lumbar instability, radiographic degenerative changes, and/or chronic centric lower back hurting [22]. Still, a repeat discectomy is more often than not more difficult due to scar tissue from the main surgery, and there is an increased the risk of dural tears or nerve injury [23]. Furthermore, using a minimally invasive percutaneous endoscopic method was determined to be effective in decreasing the risk of fusion and haemorrhage with reoperation in comparison to conventional revision discectomy [23]. A retrospective report by Ambrossi, et al. constitute a substantial amount of healthcare costs associated with recurrent disc herniation averaging $26,593 per patient to diagnose and manage [24]. All in all, it is nevertheless unclear which method has shown to be more constructive for reoperation.
There are currently no studies directly comparing the various treatments of rDHs. The goal of this systematic review is to compare the various handling options for rDH and make up one's mind if 1 intervention provides improve outcomes than the others. More than specifically, if at that place is a departure in outcomes from surgery with and without fusion.
The PICOS format is a technique used to help codify a clinical question and guide the subsequent literature search to provide an evidence-based technique to acquire clinical information from the literature [25-26]. Applying the PICOS format in developing this systematic review, nosotros established the following criteria:
- Participants: Adults ≥ 18 with recurrent disc herniation
- Interventions: discectomy, minimally invasive surgical (MIS) discectomy, posterolateral fusion (PLF), posterior lumbar interbody fusion (PLIF), transforaminal interbody fusion (TLIF), anterior lumbar interbody fusion (ALIF)
- Comparisons: discectomy, MIS discectomy, PLF, PLIF, TLIF, ALIF
- Outcomes: whatsoever
- Written report Designs: any
The hope is that this study, with the above criteria, will help to make up one's mind the advantages and disadvantages of diverse interventions to care for rDH.
Materials and methods
Literature search
A literature search was performed using PubMed with the search term "recurrent disc herniation" with MeSH terms "intervertebral disc displacement", "reoperation", and "recurrence". The search was performed on June five, 2015. Studies were excluded if they did not address the treatment of recurrent disc herniation, did not state the specific intervention being studied, did not report validated outcomes of that specific intervention, or did not have an adequate sample size (which was arbitrarily determined to be ≥ 10 patients per study grouping). No preference was taken to the type of written report (prospective, retrospective, etc.), the length of follow-up, or status of publication. Ultimately, we included papers that had covered a specific surgical treatment pick for recurrent lumbar disc herniation that reported the outcomes of the intervention from different studies with an adequate sample size. We get-go reviewed the abstracts of all the articles that populated following the search for inclusion and exclusion criteria. Then, an in-depth review of each private commodity was conducted for further inclusion into our analysis.
Data variables
While reading through each paper, we looked at the blazon of surgery used, study blazon, length of follow-up, time spent in the operating room, estimated blood loss, costs associated with re-performance, visual analogue scale ratings (VAS, pre- and postoperatively), Oswestry Inability Alphabetize (ODI, pre- and postoperatively), length of stay (LOS), re-operation outcomes, complications with re-operation, and percent with good or excellent outcomes. Percent differences of preoperative and postoperative VAS and ODI were calculated by dividing the deviation over the preoperative score:
In calculating the percent difference in VAS and ODI, we were able to establish an internal command for each study and more accurately present the average changes in subjective and objective outcomes subsequently surgery rather than comparison the raw numbers from each written report.
Results
Using the queries listed above, a search through PubMed resulted in 106 abstracts that met initial screening criteria. Conscientious assay of these 106 articles brought u.s.a. to 27 that fit the inclusion criteria to be part of the assay. Of note, some of these 27 articles discussed more than one blazon of surgery. At that place were viii articles studying echo surgery with fusion, 17 without fusion, and two studying both. A summary of these papers is listed is listed in Tables 1- 2.
Tabular array 1
Treatment of Recurrent Disc Herniation without Spinal Fusion Studies
EBL: Estimated Blood Loss; VAS: Visual Analog Scale; ODI: Oswestry Disability Index; LOS: Length of Stay; TLIF: Transforaminal Interbody Fusion; DVT: Deep Vein Thrombosis; PLF: Posterior Lumbar Fusion; JOA: Japanese Orthopedic Association; NR: Not Reported; CSF: Cerebrospinal Fluid; PDTS: Posterior Dynamic Transpedicular Stabilisation; PELD: Percutaneous Endoscopic Lumbar Discectomy; OLM: Open up Lumbar Discectomy
| Article | Surgery Type | N (% Female) | Study Type | Boilerplate Follow-Up, Months (Range) | OR Fourth dimension, Minutes (Range) | EBL, mL (Range) | Costs | Pct Change in VAS | Percent Change in ODI | Postop LOS, Days (Range) | Outcomes | Percent Showing Good or Splendid Outcomes | Complications in Repeat Surgery | |
| i | El Shazly, 2013 [27] | Discectomy | 15 (46.7%) | Prospective, Randomized, Comparative | 38.half-dozen ± 7.73 | 125.iii ± 25.32 | 256.7 ± 67.13 | $1,520 ± 36.84 | +52.17% in JOA score | NR | three.4 | Overall, all three methods showed meaning improvements postoperatively. Discectomy with fusion was associated with better improvement in hurting and less complications. PLF was more cost-constructive compared to TLIF | 86.70% | Recurrent herniation x1, postop instability x1, postop neurological deficit x2, dural tear 10 4 |
| Discectomy with TLIF | xv (xl%) | 36.iii ± eight.06 | 194 ± 25.58 | 653.3 ± 183.68 | $2,776.7 ± 56.27 | +lxx.0% in JOA score | NR | 3.5 | 93.xxx% | Postop neurological deficit x1, dural tear x2, DVT x1 | ||||
| Discectomy with PLF | fifteen (46.7%) | 36.1 ± 8.05 | 186 ± 16.82 | 660 ± 164.97 | $2,186.7 ± 52.33 | +sixty.71% in JOA score | NR | 3.3 | 86.70% | Dural tear x1, superficial wound infection x1 | ||||
| two | Kim, 2012 [37] | Microdiscectomy with CO2 Light amplification by stimulated emission of radiation Dissection | 21 (42.9%) | Retrospective | 30 (ix - 36) | NR | NR | NR | -threescore.53% | -61.32% (Korean version of ODI) | 5.14 (2 - fifteen) | Significant improvement of pain postoperatively in relation to VAS and ODI | NR | None |
| three | Ahsan, 2012 [30] | Discectomy | 18 (22.%2) | Retrospective | NR (12-48) | 141 ± 9 | NR | NR | -83.53% | -77.92% | 5 (3 - 8) | Results of repeat discectomy comparable to primary surgery | 85% | Human foot drop x1, dural tear x3, superficial wound infection x1 |
| 4 | Shin, 2011 [23] | Endoscopic Discectomy | 41 (31.vii%) | Retrospective | xvi (13-42) | 37 (25 - 96) | Minimal | NR | Back Hurting: -34.48%; Leg Hurting: -67.05% | NR | NR | Much improvement in pain without serious neurological deficits or compliations | ninety.xx% | Thecal sac injury with CSF leak x2, transient postoperative dysesthesia x2, recurrence x2, |
| five | Kaner, 2010 [36] | Microdiscectomy with PDTS | 40 (42.v%) | Prospective | 41 (24 - 63) | NR | NR | NR | -86.57% | -88.56% | NR | Satisfactory improvement in VAS/ODI scores at 2-yr follow-upwardly | NR | Strange body reaction x1, repeat operation for dynamic system removal and fusion x1 |
| 6 | Lee, 2009 [39] | PELD | 25 (36.0%) | Retrospective | 34.0 ± 4.4 | 45.8 ± xi | NR | NR | Back: -58.57% Leg: -65.48% | -66.xl% | 0.9 ± 0.v | PELD and OLM both showed favorable outcomes, simply PELD with shorter OR fourth dimension, shorter LOS, and better disc summit preservation compared to OLM | NR | 1 patient with persistent leg pain underwent repeat operation with OLM; Recurrence in one patient |
| Open Lumbar Microdiscectomy | 29 (24.1%) | 34.6 ± 4.6 | 73.8 ± 25.7 | Back: -42.59% Leg: -59.30% | -71.16% | 3.8 ± 1.4 | Dural tear x2, voiding difficulty and perineal dysesthesia x1; Recurrence in iii patients | |||||||
| seven | Kim, 2009 [38] | Microdiscectomy | 14 (21.4%) | Retrospective | 56 (36-72) | NR | NR | NR | NR | NR | NR | The surgical result of first operation was 79.seven% ± 9.3% and of the second operation was 77.eight% ± 10.4% | NR | NR |
| 8 | Ambrossi, 2009 [24] | Conservative | half dozen | Retrospective | 12 | NR | NR | $2,315 | NR | NR | NR | five patients underwent a unmarried epidural steroid injection and 4 patients underwent four weeks of outpatient physical therapy | NR | NR |
| Discectomy | 11 | $39,836 | 1 patient without symptom relief later on surgery who subsequently underwent fusion | |||||||||||
| 9 | Guo, 2009 [29] | Discectomy past Fenestration | 51 (25.v%) | Retrospective | 146.viii | NR | NR | NR | +64.8% in JOA score | NR | NR | eight patients (15.seven%) failed revision open lumbar discectomy by fenestration | 70.threescore% | five dural tears, 2 nerve root injuries, and one deep infection |
| 10 | Palma, 2008 [32] | Discectomy | 95 (30.5%) | Retrospective | NR | 110 | NR | NR | NR | NR | NR | Overall longer OR fourth dimension for reoperation compared to master surgery (110 vs. 75) and an unsuccessful surgery rate of 2% | 89% (compared to 95% after primary operation) | 4 dural tears |
| eleven | Hoogland, 2008 [35] | Endoscopic Transforaminal Discectomy | 262 (29%) | Prospective | 24 | NR | NR | NR | -66.71% in back hurting; -69.fourteen% in leg pain | NR | NR | Average improvement of back pain of 5.71 points and v.85 points of leg pain on the VAS scale | 85.71% | 10 patients with complications (three.82%): 3 nervus root irritations and 7 early recurrent herniations |
| 12 | TS Fu, 2005 [22] | Discectomy | 23 | Retrospective | 88.seven (60 –134) | 100.ix ± 22.8 | 162.7 ± 106.viii | NR | +62.45% in JOA score | NR | four.vii ± ane.four | Intraoperative blood loss, length of surgery, and length of hospitalization were significantly less in patients undergoing discectomy alone than in patients with fusion. | 78.3% based on JOA score | 3 dural tears |
| Discectomy with PLF | 18 | 166.iii ± 26.vii | 546.vii ± 206.1 | NR | +66.02% in JOA score | NR | half dozen.two ± ane.1 | 83.3% based on JOA score | 1 superficial infection, ii dural tears, 3 residue donor site hurting | |||||
| 13 | LY Dai, 2005 [28] | Discectomy | 39 (41%) | Retrospective | 92 | NR | NR | NR | +58.62% in JOA score | NR | NR | The outcomes of repeat discectomy for recurrent disc herniation were satisfactory; 29/39 returned to previous work status or normal daily activities | 74.36% with excellent outcomes | 7 dural tears |
| xiv | Ahn, 2004 [33] | PELD | 43 (25.6%) | Retrospective | 31 (24-39) | 51 (25-100) | NR | NR | -70.41% | NR | NR | The per centum of successful outcomes was 81.4%, whereas the rate of improvement was 95.iii% | 81.40% | i with incomplete decompression and was converted to open discectomy; 2 with transient dysesthesia |
| 15 | Suk, 2001 [45] | Discectomy | 28 (xl.0%) | Retrospective | NR | 88.9 | NR | NR | NR | NR | 12.nine | Conventional open discectomy as a revision surgery for recurrent lumbar disc herniation showed satisfactory results that were comparable with those of master discectomy | NR | NR |
| xvi | Cinotti, 1998 [34] | Microdiscectomy | 26 (31.0%) | Prospective | 24 months | NR | NR | NR | UTD | NR | one.5 (i-3) | 17 patients were able to return to full employment and 4 were able to return to regular daily activities at same level as prior to principal discectomy | 81% | ii dural tears, one with postop discitis, 1 with 2d recurrent herniation |
| 17 | Silvers, 1994 [twoscore] | Microdiscectomy | 82 (35.0%) | Retrospective | 46.8 (< 12-168) | NR | NR | NR | NR | NR | 4.vii | Patients who presented within one yr of primary surgery with same level and same side recurrence had poor outcomes following microdiscectomy | NR | 10 dural tears (4 with CSF leakage), 6 wound infections, two pseudomeningoceles, 1 wound hematoma |
| 18 | Herron, 1994 [31] | Laminectomy and Discectomy | 46 | Retrospective | 54 (12-128) | NR | NR | NR | NR | NR | NR | Satisfactory outcomes in treatment of rLDH without associated spinal instability. Well-nigh patients experienced "practiced" surgical outcomes with >75% relief in back and leg pain | >75% with expert surgical outcomes | NR |
| 19 | Hou, 2015 [46] | Repeat Microendoscopic Discectomy | 25 (52%) | Prospective | 36 (12-72) | 85 (60-100) | 68 (20-100) | NR | Leg Pain: -71.6% | -54.80% | NR | No nerve root or cauda equina injury | 96% | Pocket-sized dural tear x3, Recurrence x1 resulting in fusion |
Table 2
Treatment of Recurrent Disc Herniation with Spinal Fusion Studies
EBL: Estimated Claret Loss; VAS: Visual Analog Scale; ODI: Oswestry Disability Index; LOS: Length of Stay; PLF: Posterior Lumbar Fusion; PLIF: Posterior Lumbar Interbody Fusion; NR: Not Reported; UTI: Urinary Tract Infection; TLIF: Transforaminal Lumbar Interbody Fusion; MIS: Minimally Invasive Surgery; DVT: Deep Vein Thrombosis; JOA: Japanese Orthopedic Clan; PSI: Pedicle Screw Instrumentation; UTD: Unable to Decide; PSF: Posterior Spinal Fusion
| Article | Surgery Blazon | N (% Female) | Study Type | Average Follow-Up, Months (Range) | OR Time, Minutes (Range) | EBL, mL (Range) | Costs | Percent Change in VAS | Percent Modify in ODI | Postop LOS, Days (Range) | Outcomes | Percent Showing Practiced or Excellent Outcomes | Complications in Repeat Surgery | |
| 1 | Niu, 2005 [41] | PLF/PLIF past Dual Cages | fourteen (43%) | Prospective | 25 (xiv-36) | 230 (150 - 350) | 623 (200 - one,300) | NR | NR | NR | NR | No neurological deficits. | 93% | Superficial wound infection x2, UTI x1, wedged disc x1 |
| 2 | Li, 2015 [48] | TLIF | 73 (42%) | Retrospective, Unrandomized, case control | 49 (12-85) | 105 (70 - 260) | 260 (90 - 800) | NR | Leg: -86.5%; Back: -84.ix% | -55.70% | eight.5 | No implant failure. Successful fusion in 92.three%. No permanent neurological deficit | 91.80% | Dural laceration x3, transient neuro deficits x5, revision surgery x3 |
| three | Omid-Kashani, 2014 [47] | TLIF | 51 (59%) | Retrospective | 31.4 (25-50) | NR | NR | NR | Leg: -54%; Dorsum: -55.ane% | -61.90% | NR | Fusion rate 100%, no instrument failure | 74.60% | Iatrogenic partial L5 root injury x1 |
| 4 | Niesche, 2014 [43] | MIS-TLIF | 14 | Retrospective | 52 (48 - 59) | 140 (95 - 190) | 150 (120 - 370) | NR | -56.52% | -64.71% | 5 (3 - 7) | Solid radiographic fusion at 24 months; no evolution of adjacent disc disease | 85% | None |
| Open-TLIF | 19 | 130 (80 - 190) | 380 (350 - 620) | NR | -56.52% | -64.71% | x (8-14) | Solid radiographic fusion at 24 months; improvement in VAS and ODI not as significant compared to MIS | 68.xxx% | four revisions due to wound healing disorders, 2 with neurologic deterioration due to radiculopathy | ||||
| 5 | Lequin, 2014 [21] | PLIF | 26 | Retrospective | 15.3 | NR | NR | NR | -46.02% | NR | NR | 85% with subjective improvement after reoperation | 46% with expert recovery | 2 hematomas, two dural tears, 4 with increased/new neurologic deficits, 1 superficial wound infection |
| vi | El Shazly, 2013 [27] | Discectomy | xv (46.seven%) | Prospective, Randomized, Comparative | 38.6 ± 7.73 | 125.iii ± 25.32 | 256.7 ± 67.13 | $1,520 ± 36.84 | +52.17% in JOA score | NR | 3.4 | Overall, all three methods showed pregnant improvements postoperatively. Discectomy with fusion was associated with better improvement in pain and less complications. PLF was more cost-effective compared to TLIF | 86.seventy% | Recurrent herniation x1, postop instability x1, postop neurological arrears x2, dural tear x 4 |
| Discectomy with TLIF | xv (40%) | 36.3 ± 8.06 | 194 ± 25.58 | 653.3 ± 183.68 | $2,776.7 ± 56.27 | +70.0% in JOA score | NR | 3.v | 93.30% | Postop neurological arrears x1, dural tear x2, DVT x1 | ||||
| Discectomy with PLF | fifteen (46.7%) | 36.1 ± 8.05 | 186 ± xvi.82 | 660 ± 164.97 | $2,186.vii ± 52.33 | +60.71% in JOA score | NR | 3.3 | 86.seventy% | Dural tear x1, superficial wound infection x1 | ||||
| seven | Sonmez, 2013 [2] | Unilateral MIS-TLIF with Pedical Screw Instrumentation | 10 (60%) | Prospective | 24 | 100 | 150 | ii,900 Turkish Lira | -78.82% | -55.07% | two.2 | Unilateral MIS TLIF with PSI had comparable results to bilateral instrumentation in improving back pain and was much more toll-constructive | NR | None |
| Bilateral MIS-TLIF with Pedical Screw Instrumentation | ten (50%) | 147 | 165 | 4,700 Turkish Lira | -79.76% | -50.68% | 2.3 | NR | None | |||||
| 8 | Chen, 2009 [49] | TLIF | 43 | UTD | 45 (24-72) | NR | NR | NR | +62.8% in JOA score | NR | NR | The mean JOA score was improved from 9.3 before surgery to 25.0 at the final follow-up visit. The fusion rate was 100% two years postoperatively. No implant failure | 86.i% based on JOA score | Three patients (7%) had transient neurological deficits |
| 9 | Fu, 2005 [22] | Discectomy | 23 | Retrospective | 88.7 (60 –134) | 100.9 ± 22.viii | 162.vii ± 106.8 | NR | +62.45% in JOA score | NR | iv.7 ± one.4 | Intraoperative blood loss, length of surgery, and length of hospitalization were significantly less in patients undergoing discectomy alone than in patients with fusion. | 78.3% based on JOA score | 3 dural tears |
| Discectomy with PLF | 18 | 166.iii ± 26.vii | 546.vii ± 206.ane | NR | +66.02% in JOA score | NR | 6.2 ± 1.one | 83.three% based on JOA score | 1 superficial infection, ii dural tears, and 3 residual donor site pain | |||||
| x | Huang, 2002 [42] | PLIF with single, cardinal cage and bilateral PSF | 28 (64.three%) | Retrospective | 14.iv (8-39) | NR | NR | NR | NR | NR | NR | Charge per unit of bony fusion was 82.14%. Several patients with improved economic and functional status | 92.86% | 1 dural tear, one with transient paresthesias, and one with transient bladder atony |
Of the 27 articles reviewed for analysis, seven discussed outcomes from discectomy, 10 from a minimally invasive discectomy, v from TLIF, 2 from PLIF, one from both PLF/PLIF, and two comparative studies comparing discectomy and discectomy with fusion (Figures ane- 2) [22, 27]. Six of the twenty-vii manufactures either had a follow-up time < 24 months or were non reported; the other 21 articles had at least a 24-calendar month follow-upwardly. At that place were 7 prospective studies (26%), nineteen retrospective studies (70%), and 1 where we were unable to make up one's mind whether it was a prospective or retrospective study.
Number of Papers past Type of Surgery
MIS: Minimally Invasive Surgery, PLF: Posterior Lumbar Fusion, PLIF: Posterior Lumbar Interbody Fusion, ALIF: Inductive Lumbar Interbody Fusion
Number of Papers past Blazon of Surgery and Year of Publication
MIS: Minimally Invasive Surgery, PLF: Posterior Lumbar Fusion, PLIF: Posterior Lumbar Interbody Fusion, TLIF: Transforaminal Lumbar Interbody Fusion, ALIF: Anterior Lumbar Interbody Fusion
Discectomy
Of the nine manufactures reporting on the outcomes of discectomy for rDH, 5 (55.5%) reported VAS, JOA, or ODI scores for their study population. Of the five that did report these variables, 4 were on the JOA scale, which is a modified ODI [22, 27-29]. The percent improvement in JOA amid these studies ranged from 52.17% to 64.eight%. Only one study reported ODI scores [30]. As a issue, no accurate calculations can be made to make up one's mind the average VAS and ODI changes after discectomy for rDH. Seven of the ix studies reported the pct of patients showing good or excellent outcomes, which ranged from 70.60% to 89% [29, 31-32]. Of the total 326 patients undergoing discectomy from 9 studies, dural tear was the most common complexity reported occurring in 26 patients (8%) with three studies non reporting on complications. One reherniation occurred in 0.iii% [27]. Neurological deficits or nerve root injuries occurred in 5 patients (1.5%).
Minimally invasive discectomy
Of the ten manufactures reporting on the outcomes of minimally invasive discectomy for rDH, vi (60%) reported VAS and four (twoscore%) reported ODI. Pct comeback in VAS amid these studies ranged from 50.77% to 86.57%, indicating an overall hurting reduction later operation for rDH using a minimally invasive discectomy. Per centum comeback in ODI ranged from 61.32% to 88.56% (based on preoperative and postoperative values). 4 of the nine studies reported the percent of patients showing good or excellent outcomes, which ranged from 81% to xc.2% [23, 33-40]. Of the total 579 patients undergoing minimally invasive discectomy, dural tear was the most common complication reported and occurred in 23 patients (4%). Twelve patients had reherniation (2%). One of the 10 articles reviewed did not study on complications [38]. Neurological complications occurred in seven patients (1.two%): four with transient dysesthesia and three with nerve root irritations.
Posterolateral fusion (PLF)
Three studies were noted to have evaluated patients undergoing PLF afterwards rDH. One of these studies performed PLIF in 12 of the 14 patients evaluated, so it was instead excluded from this category [39]. The two remaining studies analyzed the PLF treatment in rDH and reported back pain based on the JOA scale, showing an improvement past lx.71% and 66.02% [22, 27]. El Shazly, et al. and Fu, et al. reported good or excellent outcomes in 86.70% and 83.3%, respectively. El Shazly, et al. also constitute PLF to be more than price effective than TLIF, but patients undergoing TLIF had a amend improvement in JOA score (70% vs. 60.7%, respectively) and a larger percentage showing either good or excellent outcomes (93.3% vs. 86.7%). Fu, et al. found much longer OR times and larger EBL with PLF compared to discectomy lone simply, overall, showed better outcomes with PLF. Of the 33 patients from the two studies who underwent PLF, iii patients had dural tears (nine%) and two had superficial wound infections (vi%).
Posterior lumbar interbody fusion (PLIF)
One of the 3 studies analyzed reported preoperative and postoperative VAS with a percent improvement of 46.02% [21]. Lequin, et al. reported 46% with proficient outcomes, Huang, et al. reported 92.86% with proficient or first-class outcomes, and Niu, et al. reported 93% with proficient or first-class outcomes [21, 41-42]. There were 68 patients who underwent PLIF betwixt the iii studies reviewed. Iii patients had dural tears (4.4%) and 6 patients had neurological complications (8.8%). The neurological complications included worsening or new neurological deficits in four patients, one patient with transient paresthesias, and 1 patient with bladder atony.
Transforaminal lumbar interbody fusion (TLIF)
4 of the six studies used the VAS metric to assess pain while the other 2 utilized the JOA calibration. VAS improvement ranged from 54% to 86.5%. JOA scale modify comeback was reported from 62.8% to 70%. Pct showing good or excellent outcomes ranged from 68.three% to 93.3% in the 5 studies reporting these findings. Niesche, et al. found no complications utilizing a minimally invasive TLIF arroyo with 85% showing good or first-class outcomes [43]. There were 216 patients who underwent TLIF from the 6 studies reviewed. Five patients (two.3%) had dural tears, ten with neurological deficits postoperatively (four.6%), and three requiring revision surgery (1.3%).
Discussion
In reviewing the 23 articles that reported treatment outcomes for rDH, it is still difficult to ascertain which intervention is the most appropriate to use. All of the papers showed overall positive results in relieving pain when comparing preoperative and postoperative functional outcome measures, such every bit the VAS, JOA, and ODI. VAS and ODI are currently the most valuable resources of objective information in measuring the level of success. It is difficult, still, to identify any objective measures of success through radiographic imaging. A study by Cheng, et al. looked at the rate of first-fourth dimension recurrent herniations in 207 patients based on the blazon of main surgery and found that at that place was a lower rate of recurrence using a traditional open approach versus a microendoscopic discectomy or percutaneous endoscopic discectomy (37.8% vs. 47.1% and 70.6%, respectively) [44]. At that place is an insufficient amount of published data to help determine the most appropriate method of treating rDH at this time. Being that disc herniation is one of the virtually common back problems requiring surgical intervention, identifying the advisable methods to accurately diagnose and treat rDH with standard outcomes measures would exist worthwhile to investigate. This would also help to establish the about toll-constructive intervention (surgical and non-surgical) with the everyman associated morbidity.
The choice between repeat discectomy and discectomy with fusion for rDH has been a highly debated topic [45-49]. In one perspective, fusion is usually costlier, associated with more than complications, longer OR times, larger EBL, and longer hospitalizations. In the analysis performed here, it seems that TLIF is the more superior fusion option based on the greatest subtract in VAS/ODI compared to the other fusion studies reviewed. However, the lack of published data on other forms of fusion and express comparative studies makes it more difficult to accurately make this determination. One of the two comparative studies reviewed by Fu, et al. compared discectomy and discectomy with PLF and found better improvement of pain afterwards fusion. Yet, fusion was too associated with more complications, more blood loss, and longer operative times compared with discectomy alone [22].
From a surgical decision-making perspective, it was hard to make up one's mind indications or a reliable algorithm for option of fusion for rDH from the manufactures reviewed. Mroz, et al. published their findings from a survey identifying the surgical treatment patterns among spine surgeons in the Us for lumbar rDH and found that the number of surgeries performed and years of do had a statistically meaning bear upon on the type of surgery performed [20]. They concluded that a surgeon practicing for 15-twenty years is less likely to perform a revision microdiscectomy with fusion versus revision microdiscectomy lone. However, they likewise institute that higher volume surgeons with > 200 cases per year were more probable to perform a fusion to address rDH. This variance could be indicative of multiple factors, including surgeon preference and patient characteristics, but nosotros need to consider the lack of proper evidence-based information as a likely reason for the lack of definitive recommendations. One consideration is to use the National Neurosurgery Quality and Outcomes Database (N2QOD) registry, which is a prospectively collected sampling of patients who experienced same-level, aforementioned-side rDH, had either a discectomy or arthrodesis, and had 1-twelvemonth follow-up [l]. This registry collects the same information variables on all patients, which allows for meliorate statistical analysis than when trying to combine information in a meta-analysis. Additionally, this will assist in performing more than accurate comparative analyses to determine indications or generate a reliable algorithm for the treatment of rDH. The abstruse past McGirt, et al. found greater healthcare utilization and morbidity with arthrodesis in their comparative assay of 417 patients in the N2QOD registry and concluded that revision discectomy is the more efficient treatment option [50].
In regards to reporting the rates of reherniation, 1 concern in the literature is the lack of distinguishability between radiographic evidence of reherniation and symptomatic reherniation. Lebow, et al. establish that almost i-fourth of patients who underwent a lumbar discectomy had radiographic prove of reherniation with the majority beingness asymptomatic [51]. Furthermore, these asymptomatic reherniations did not develop whatever clinical consequences at the two-twelvemonth follow-up. In regards to the studies reviewed in this assay, information technology is unclear whether they had radiographic or symptomatic evidence of reherniation. For example, Vik, et al. reported outcomes on 39 patients who underwent revision surgery due to suspected herniation simply so found that recurrence had been establish in just 14 of them [52]. Similarly, Ozgen, et al. studied 114 patients with previous lumbar disc surgery who underwent re-exploration and found that but 56 had a truthful recurrence of herniation [18]. Epidural fibrosis, a major intraoperative finding in non-rDH revision surgeries, is frequently difficult to distinguish with advanced imaging and presents with like clinical symptomology. This has been shown in previously published studies to be associated with poor results from revision surgical intervention [53-57]. It appears from these reported data that many patients who do non have a true recurrence are still undergoing surgical treatment in identify of a more bourgeois management without the morbidity of a second operation. Formulating a more physical set of diagnostic criteria for rDH would help delineate the utilize of symptomatic versus radiographic diagnosis. It would exist worthwhile to perform a comparative analysis along with a toll-effectiveness analysis to determine if the costs of imaging to diagnose rDH outweigh the costs of unnecessary operations for patients who were incorrectly diagnosed or having clinical symptomatology lonely.
In our review of the literature for the cervical and thoracic spine, the rates of rDH were rarely mentioned. Although the incidence of rDH in these spinal regions occurs less oft compared to the lumbar spine, the management is somewhat similar. It would exist of value to determine the efficacy of these various interventions to better guide our treatment algorithms.
Written report limitations
Some of the limitations of this report include the small number of papers currently published on the treatment of rDH and the reporting of standardized outcome measures. Additionally, of the papers that were included, there was a broad spectrum of definitions of rDH, making it difficult to compare the patients selected for treatment and their outcomes. The lack of uniformity in postoperative information drove was further amplified by not all of the studies reporting like time points after surgery for postoperative VAS and ODI. The possible variability in when the VAS and ODI were recorded in each paper could be a limitation that nosotros were unable to correct for, given the information reported.
Future outlook/recommendations
Future studies assessing outcomes of the treatment of recurrent disc herniation are needed in order to establish a better perspective on the proper approach to and management of recurrent disc herniation. Studies using registries can aid improve elucidate these questions past allowing more comparative analyses to be done and piece of work towards making more authentic handling recommendations and algorithms [45]. This includes further investigation of adventure factors for recurrence and comparative studies on the outcomes of these surgical techniques. Identifying truthful hazard factors for recurrent herniation can aid stratify patients for different treatment options and possibly have an impact on costs if reherniation tin be avoided. Another consideration is the question of accurate versus precise diagnosis of recurrence. Although information technology is difficult correct now to plant an accurate diagnosis, having a better definition of rDH would allow for better precision and standardization of what the literature describes every bit rDH. Several of the studies reviewed noted performing MRIs on each patient to determine if reherniation had occurred, but this may not be necessary or the most toll-effective method of diagnosis and treatment.
We developed a gear up of recommendations for future studies on surgical outcomes, which are summarized in Table 3. In guild to reach more accurate results on the outcomes of a surgical intervention for rDH, prospective studies with a minimum two-year follow-up are needed to properly assess the long-term implications after surgery. We hope that these factors, along with already published reporting guidelines, will help produce studies that tin can change the mode patients are treated for rDH in the future.
Table 3
Recommendations for Futurity Studies in Recurrent Disc Herniation Treatment.
| Recommendations: |
| 1. How recurrence of disc herniation was determined (imaging, symptomatology, etc.) |
| 2. Which level and side (ipsilateral or contralateral) the reherniation was located |
| 3. Time frame afterward main performance |
| 4. Which intervention(s) are existence studied |
| four. Reporting of preoperative VAS/ODI |
| 5. Reporting postoperative VAS/ODI immediately afterward surgery and at 6-calendar month intervals for at to the lowest degree two years |
| 6. Percentage with skillful or excellent outcomes using MacNab's assessment |
| 7. Complicating factors to reherniation (i.e. fibrosis, etc.) |
| eight. Time until return to work or regular daily activities |
Conclusions
The current analysis was not able to conclude on any pregnant departure in outcomes in comparing one surgical method to some other. This is largely based on the lack of standardized reporting of outcomes in the literature, which makes it difficult to combine these data points for assay with such a small power. However, in reviewing the few selected articles that met our stringent criteria, nosotros concluded that fusion may have a greater improvement in pain and functional outcomes compared to reoperation without fusion at the cost of more complications, increased blood loss, and longer operative times for the handling of rDH.
Notes
The content published in Cureus is the result of clinical experience and/or research by independent individuals or organizations. Cureus is not responsible for the scientific accuracy or reliability of information or conclusions published herein. All content published inside Cureus is intended only for educational, inquiry and reference purposes. Additionally, manufactures published within Cureus should not be deemed a suitable substitute for the communication of a qualified health care professional person. Practice not condone or avoid professional medical advice due to content published inside Cureus.
The authors take alleged that no competing interests be.
Human Ideals
Consent was obtained by all participants in this report
Animal Ethics
Animal subjects: This study did not involve creature subjects or tissue.
References
1. Recurrent lumbar disc herniation. Swartz KR, Trost GR. Neurosurg Focus. 2003;15:0. [PubMed] [Google Scholar]
2. Unilateral percutaneous pedicle spiral instrumentation with minimally invasive TLIF for the treatment of recurrent lumbar deejay illness: ii years follow-up. Sonmez Eastward, Coven I, Sahinturk F, Yilmaz C, Caner H. Turk Neurosurg. 2013;23:372–378. [PubMed] [Google Scholar]
iii. Microdiscectomy for recurrent L5-S1 disc herniation. Berjano P, Pejrona M, Damilano Grand. Eur Spine J. 2013;22:2915–2917. [PMC complimentary article] [PubMed] [Google Scholar]
four. Recurrent versus main lumbar disc herniation surgery patient-reported outcomes in the Swedish Spine Register Swespine. Fritzell P, Knutsson B, Sanden B, Strömqvist B, Hägg O. Clin Orthop Relat Res. 2015;473:1978–1984. [PMC gratuitous article] [PubMed] [Google Scholar]
5. Recurrence subsequently successful percutaneous endoscopic lumbar discectomy. Kim JM, Lee SH, Ahn Y, Yoon DH, Lee CD, Lim ST. Minim Invasive Neurosurg. 2007;50:82–85. [PubMed] [Google Scholar]
6. Recurrent disc herniation and long-term back pain subsequently principal lumbar discectomy: review of outcomes reported for limited versus aggressive disc removal. McGirt MJ, Ambrossi GL, Datoo G, Sciubba DM, Witham TF, Wolinsky JP, Gokaslan ZL, Bydon A. Neurosurgery. 2009;64:338–344. [PubMed] [Google Scholar]
seven. A prospective accomplice study of close interval computed tomography and magnetic resonance imaging after principal lumbar discectomy: factors associated with recurrent disc herniation and disc height loss. McGirt MJ, Eustacchio S, Varga P, Vilendecic Thou, Trummer M, Gorensek One thousand, Ledic D, Carragee EJ. Spine (Phila Pa 1976) 2009;34:2044–2051. [PubMed] [Google Scholar]
8. Obesity increases the hazard of recurrent herniated nucleus pulposus after lumbar microdiscectomy. Meredith DS, Huang RC, Nguyen J, Lyman South. Spine J. 2010;10:575–580. [PubMed] [Google Scholar]
9. Results and take chances factors for recurrence post-obit single-level tubular lumbar microdiscectomy. Moliterno JA, Knopman J, Parikh K, Cohan JN, Huang QD, Aaker GD, Grivoyannis Advertizement, Patel AR, Härtl R, Boockvar JA. J Neurosurg Spine. 2010;12:680–686. [PubMed] [Google Scholar]
11. Recurrence rate after herniotomy only versus discectomy in lumbar disc herniation. Park JS, Choi SE, Cho TK, Kim SH, Rhee W, Kim WJ, Ha SI, Lim JH, Jang IT. Korean J Spine. 2013;10:227–231. [PMC costless article] [PubMed] [Google Scholar]
12. Obesity and recurrent intervertebral disc prolapse later lumbar microdiscectomy. Quah C, Syme Chiliad, Swamy GN, Nanjayan Due south, Fowler A, Calthorpe D. Ann R Coll Surg Engl. 2014;96:140–143. [PMC free article] [PubMed] [Google Scholar]
xiii. Risk factors of recurrent disc herniation. Reith C, Lausberg M. Neurosurg Rev. 1989;12:147–150. [PubMed] [Google Scholar]
fourteen. Risk factors of recurrent lumbar disk herniation. Shimia M, Babaei-Ghazani A, Sadat BE, Habibi B, Habibzadeh A. Asian J Neurosurg. 2013;8:93–96. [PMC complimentary article] [PubMed] [Google Scholar]
15. Shin BJ. Asian Spine J. Vol. 8. 24761206; PubMed Central: 2014. Gamble factors for recurrent lumbar disc herniations; pp. 211–215. [PMC free article] [PubMed] [Google Scholar]
16. College adventure of dural tears and recurrent herniation with lumbar micro-endoscopic discectomy. Teli M, Lovi A, Brayda-Bruno Thousand, Zagra A, Corriero A, Giudici F, Minoia 50. Eur Spine J. 2010;19:443–450. [PMC free article] [PubMed] [Google Scholar]
17. Yoo MW, Hyun SJ, Kim KJ, Jahng TA, Kim HJ. Korean J Spine. Vol. eleven. 25110486; PubMed Central: PubMed PMID; 2014. Does obesity make an influence on surgical outcomes following lumbar microdiscectomy? pp. 68–73. [PMC free commodity] [PubMed] [Google Scholar]
xix. Guideline update for the operation of fusion procedures for degenerative affliction of the lumbar spine. Part 8: lumbar fusion for disc herniation and radiculopathy. Wang JC, Dailey AT, Mummaneni PV, Ghogawala Z, Resnick DK, Watters WC 3rd, Groff MW, Choudhri TF, Eck JC, Sharan A, Dhall SS, Kaiser MG. J Neurosurg Spine. 2014;21:48–53. [PubMed] [Google Scholar]
20. Differences in the surgical treatment of recurrent lumbar disc herniation amongst spine surgeons in the United states of america. Mroz TE, Lubelski D, Williams SK, O'Rourke C, Obuchowski NA, Wang JC, Steinmetz MP, Melillo AJ, Benzel EC, Modic MT, Quencer RM. Spine J. 2014;xiv:2334–2343. [PubMed] [Google Scholar]
21. Posterior lumbar interbody fusion with stand-alone Trabecular Metal cages for repeatedly recurrent lumbar disc herniation and dorsum pain. Lequin MB, Verbaan D, Bouma GJ. J Neurosurg Spine. 2014;20:617–622. [PubMed] [Google Scholar]
22. Long-term results of disc excision for recurrent lumbar disc herniation with or without posterolateral fusion. Fu TS, Lai PL, Tsai TT, Niu CC, Chen LH, Chen WJ. Spine (Phila Pa 1976) 2005;thirty:2830–2834. [PubMed] [Google Scholar]
23. Revisional percutaneous full endoscopic disc surgery for recurrent herniation of previous open up lumbar discectomy. Shin KH, Chang HG, Rhee NK, Lim KS. Asian Spine J. 2011;5:i–9. [PMC gratis article] [PubMed] [Google Scholar]
24. Recurrent lumbar disc herniation later single-level lumbar discectomy: incidence and wellness care toll analysis. Ambrossi GL, McGirt MJ, Sciubba DM, Witham TF, Wolinsky JP, Gokaslan ZL, Long DM. Neurosurgery. 2009;65:574–578. [PubMed] [Google Scholar]
25. Utilization of the PICO framework to improve searching PubMed for clinical questions. Schardt C, Adams MB, Owens T, Keitz S, Fontelo P. BMC Med Inform Decis Mak. 2007;vii:16. [PMC costless article] [PubMed] [Google Scholar]
27. Recurrent lumbar disc herniation: A prospective comparative study of three surgical direction procedures. El Shazly AA, El Wardany MA, Morsi AM. Asian J Neurosurg. 2013;8:139–146. [PMC free article] [PubMed] [Google Scholar]
29. Long-term outcomes of the revision open up lumbar discectomy by fenestration: A follow-up study of more than than x years. Guo JJ, Yang H, Tang T. Int Orthop. 2009;33:1341–1345. [PMC free article] [PubMed] [Google Scholar]
30. Discectomy for master and recurrent prolapse of lumbar intervertebral discs. Ahsan K, Najmus-Sakeb Najmus-Sakeb, Hossain A, Khan SI, Awwal MA. http://josonline.org/pdf/v20i1p7.pdf. J Orthop Surg (Hong Kong) 2012;20:seven–10. [PubMed] [Google Scholar]
35. Endoscopic transforaminal discectomy for recurrent lumbar disc herniation: a prospective, cohort evaluation of 262 consecutive cases. Hoogland T, van den Brekel-Dijkstra Yard, Schubert M, Miklitz B. Spine (Phila Pa 1976) 2008;33:973–978. [PubMed] [Google Scholar]
36. Minimum two-twelvemonth follow-up of cases with recurrent disc herniation treated with microdiscectomy and posterior dynamic transpedicular stabilisation. Kaner T, Sasani M, Oktenoglu T, Aydin AL, Ozer AF. Open Orthop J. 2010;iv:120–125. [PMC costless article] [PubMed] [Google Scholar]
37. Usefulness of carbon dioxide laser for recurrent lumbar disc herniation. Kim JS, Oh HS, Lee SH. Photomed Laser Surg. 2012;30:568–572. [PubMed] [Google Scholar]
38. Disc height and segmental move as run a risk factors for recurrent lumbar disc herniation. Kim KT, Park SW, Kim YB. Spine (Phila Pa 1976) 2009;34:2674–2678. [PubMed] [Google Scholar]
39. Comparison of percutaneous endoscopic lumbar discectomy and open lumbar microdiscectomy for recurrent disc herniation. Lee DY, Shim CS, Ahn Y, Choi YG, Kim HJ, Lee SH. J Korean Neurosurg Soc. 2009;46:515–521. [PMC free article] [PubMed] [Google Scholar]
41. Unmarried cylindrical threaded muzzle used in recurrent lumbar disc herniation. Niu CC, Chen LH, Lai PL, Fu TS, Chen WJ. J Spinal Disord Tech. 2005;eighteen:0–72. [PubMed] [Google Scholar]
42. Clinical results of a single primal interbody fusion cage and transpedicle screws fixation for recurrent herniated lumbar disc and low-grade spondylolisthesis. Huang KF, Chen TY. http://memo.cgu.edu.tw/cgmj/2603/260303.pdf. Chang Gung Med J. 2003;26:170–177. [PubMed] [Google Scholar]
43. Percutaneous pedicle screw and rod fixation with TLIF in a series of fourteen patients with recurrent lumbar disc herniation. Niesche 1000, Juratli TA, Sitoci KH, Neidel J, Daubner D, Schackert 1000, Leimert One thousand. Clin Neurol Neurosurg. 2014;124:25–31. [PubMed] [Google Scholar]
44. Reoperation subsequently lumbar disc surgery in two hundred and 7 patients. Cheng J, Wang H, Zheng W, Li C, Wang J, Zhang Z, Huang B, Zhou Y. Int Orthop. 2013;37:1511–1517. [PMC free commodity] [PubMed] [Google Scholar]
45. Recurrent lumbar disc herniation: results of operative direction. Suk KS, Lee HM, Moon SH, Kim NH. Spine (Phila Pa 1976) 2001;26:672–676. [PubMed] [Google Scholar]
46. Repeated microendoscopic discectomy for recurrent lumbar disk herniation. Hou T, Zhou Q, Dai F, Luo F, He Q, Zhang J, Xu J. Clinics (Sao Paulo) 2015;70:120–125. [PMC free article] [PubMed] [Google Scholar]
48. Four-year follow-upwards results of transforaminal lumbar interbody fusion as revision surgery for recurrent lumbar disc herniation after conventional discectomy. Li Z, Tang J, Hou Due south, Ren D, Li Fifty, Lu X, Hou T. J Clin Neurosci. 2015;22:331–337. [PubMed] [Google Scholar]
49. Surgical handling of recurrent lumbar disc herniation by transforaminal lumbar interbody fusion. Chen Z, Zhao J, Liu A, Yuan J, Li Z. Int Orthop. 2009;33:197–201. [PMC gratis article] [PubMed] [Google Scholar]
50. Arthrodesis vs revision discectomy for recurrent lumbar disc herniation: Patient-reported outcomes in 417 patients from the N2QOD registry. Parker SL, McGirt MJ, Coric D, Kim PK, Cahill KS, Devin CJ, Asher A. Spine J. 2015;15:0. [Google Scholar]
51. Asymptomatic same-site recurrent disc herniation subsequently lumbar discectomy: results of a prospective longitudinal study with 2-year series imaging. Lebow RL, Adogwa O, Parker SL, Sharma A, Cheng J, McGirt MJ. Spine (Phila Pa 1976) 2011;36:2147–2151. [PubMed] [Google Scholar]
52. Eight year result after surgery for lumbar disc herniation: a comparison of reoperated and not reoperated patients. Vik A, Zwart JA, Hulleberg G, Nygaard OP. Acta Neurochir (Wien) 2001;143:607–610. [PubMed] [Google Scholar]
53. Microsurgical reoperation post-obit lumbar disc surgery. Timing, surgical findings, and upshot in 92 patients. Ebeling U, Kalbarcyk H, Reulen HJ. J Neurosurg. 1989;seventy:397–404. [PubMed] [Google Scholar]
54. Reoperation afterwards lumbar disc surgery: results in 130 cases. Fandiño J, Botana C, Viladrich A, Gomez-Bueno J. Acta Neurochir (Wien) 1993;122:102–104. [PubMed] [Google Scholar]
55. Re-operation afterwards lumbar disc surgery: results in 85 cases. Kayaoglu CR, Calikoğlu C, Binler Due south. J Int Med Res. 2003;31:318–323. [PubMed] [Google Scholar]
57. Differentiation betwixt postoperative scar and recurrent disk herniation: prospective comparison of MR, CT, and contrast-enhanced CT. Sotiropoulos S, Chafetz NI, Lang P, Winkler Chiliad, Morris JM, Weinstein PR, Genant HK. http://www.ajnr.org/content/10/3/639.total.pdf. AJNR Am J Neuroradiol. 1989;ten:639–643. [PMC complimentary article] [PubMed] [Google Scholar]
Articles from Cureus are provided here courtesy of Cureus Inc.
Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4922511/
0 Response to "Can You Get a Hernia Disc Again After Surgery"
Post a Comment