Recurrent lumbar disc herniation: Is there a correlation with the surgical technique? A multivariate analysis

Abstract

Purpose: The recurrence of a lumbar disc herniation (LDH) is a common cause of poor outcome following lumbar discectomy. The aim of this study was to assess a potential relationship between the incidence of recurrent LDH and the surgical technique used. Furthermore, we tried to define the best surgical technique for the treatment of recurrent LDH to limit subsequent recurrences.

Materials and methods: A retrospective study was conducted on 979 consecutive patients treated for LDH. A multivariate analysis tried to identify a possible correlation between (1) the surgical technique used to treat the primary LDH and its recurrence; (2) technique used to treat the recurrence of LDH and the second recurrence; and (3) incidence of recurrence and clinical outcome. Data were analyzed with the Pearson's Chi-square test for its significance.

Results: In 582 cases (59.4%), a discectomy was performed, while in 381 (40.6%), a herniectomy was undertaken. In 16 cases, a procedure marked as "other" was performed. Among all patients, 110 (11.2%) had a recurrence. Recurrent LDH was observed in 55 patients following discectomy (9.45%), in 45 following herniectomy (11.8%), and in 10 (62.5%) following other surgery. Our data showed that 90.5% of discectomies and 88.2% of the herniectomies had a good clinical outcome, whereas other surgeries presented a recurrence rate of 62.5% (Pearson's χ²< 0.001). No statistical differences were observed between discectomy or herniectomy, for the treatment of the recurrence, and the incidence for the second recurrences (P > 0.05). A significant statistical correlation emerged between the use of other techniques and the incidence for the second recurrences (P < 0.05).

Conclusions: The recurrence of an LDH is one of the most feared complications following surgery. Although the standard discectomy has been considered more protective toward the recurrence compared to herniectomy, our data suggest that there is no significant correlation between the surgical technique and the risk of LDH recurrence.

Keywords: Degenerative disc disease; low back pain; recurrent lumbar disc herniation; spinal degeneration; spinal instability; surgery.

Figure 1

Bar graph showing the percentage of recurrence following lumbar disc herniation treatment. No statistical differences were observed between discectomy and herniectomy in the incidence of recurrence (P> 0.05). The incidence of recurrence was significantly higher for patients treated by using other techniques (*P< 0.05)

Figure 2

Bar graph showing the percentage of second recurrence following lumbar disc herniation treatment. The results showed the absence of statistical significance between discectomy or herniectomy, for the treatment of the recurrence, and the incidence for a second recurrence (P> 0.05). The incidence of recurrence was significantly higher for patients treated by using other techniques (*P< 0.05)

Figure 3

Bar graph showing the clinical outcome following lumbar disc herniation treatment. Among the patients, 88.8% had a good outcome after the first surgery because 92.1% did not need to assume drugs for pain management and 7.9% took pain medications only occasionally following surgery. Considering the patients with the first and second recurrences, 52.7% did not need to assume drugs for pain management, 20.2% took pain medications only occasionally, and 12.4% needed a constant assumption of drugs for pain management. Among patients with the first recurrence who did not develop a second recurrence, 63.7% had a good clinical outcome, 24.2% took pain medication occasionally, and 12.1% had a constant need for pain medications. Among the patients with a second recurrence, 52.6% was in a good clinical condition, 21.1% took pain medications occasionally, and 26.3% had a continuative assumption of pain medications. Overall, patients with a worse clinical outcome were patients with second recurrence (*P< 0.05)