Fusion versus nonfusion treatment for recurrent lumbar disc herniation

Abstract

Background: Recurrent lumbar disc herniation (RLDH) is one of the major causes for failure of primary surgery. The optimal surgical treatment of RLDH remains controversial.

Aim: Retrospectively, we evaluate 135 patients and compare the clinical outcomes between fusion and nonfusion treatment of RLDH.

Methods: Records of 75 men and 35 women aged 28-60 years for conventional revision discectomy alone (nonfusion) and 15 men and 10 women aged 30-65 years for revision discectomy with transforaminal lumbar interbody fusion (TLIF) and transpedicular screw fixation (fusion) were reviewed. Demographics, surgical data, and complications were collected and pre- and postoperative assessment were done by the Visual Analogue Scale (VAS) scale and Japanese Orthopaedic Association (JOA) score. The results after surgery were assessed according to the recovery rate as excellent, good, fair, and poor.

Results: The mean follow-up period was 28.8 and 24.6 months in Group A (nonfusion) and Group B (fusion group), respectively. The preoperative data between both the groups showed no statistically significant difference. The postoperative mean VAS and JAO scores, recovery rate, and satisfaction rate showed no statistically significant difference except postoperative low back pain and occasional radicular pain and neurological deficit in nonfusion group which was significantly higher than that of fusion group. In comparison to fusion group, nonfusion group required significantly less operative time, less intraoperative blood loss, less postoperative hospital stay, no blood transfusion, and less total cost of the procedure. Satisfaction rate was 80% and 88% in nonfusion and fusion groups, respectively.

Conclusions: Both convention revision discectomy (nonfusion) and discectomy with instrumented fusion (TLIF) surgery are effective in patients with RLDH.

Keywords: Conventional revision discectomy alone (Non fusion); recurrent lumbar disc herniation; transforaminal lumbar interbody fusion and stabilization.

Figure 1

Revision discectomy. (a and b) sagittal and axial view T2 W magnetic resonance imaging showing disc herniation at L4–L5 level and left-sided primary discectomy done on April 2016. (c and d) sagittal and axial view T2W magnetic resonance imaging at the same level showing recurrent disc prolapse at L4–L5 level, revision discectomy done on February 13, 2018, (e and f) flexion and extension view shows no signs of instability

Figure 2

Revision discectomy and Instrumented fusion. (a and b) dynamic X-ray lumbar spine before primary discectomy showing no instability, (c and d) sagittal and axial T2W MRI showing disc prolapse at L4–L5 level, bilateral fenestration and right-sided discectomy was done on October 2015, (e and f) dynamic X-ray lumbar spine before revision discectomy and instrumented fusion showing anterior listhesis L4 over L5, (g and h) sagittal and axial T2W MRI showing recurrent disc herniation at L4–L5 level, (i) showIing TLIF with titanium banana cage with bone graft and stabilized by pedicle screw and rod on March 2018