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. 2023 Jun 15;15(6):e40469.
doi: 10.7759/cureus.40469. eCollection 2023 Jun.

Repeat Discectomy for the Management of Same-Level Recurrent Disc Herniation: A Study of 50 Patients

Gerald Musa  1   2 , Serik K Makirov  3 , Sergey V Susin  4 , Gennady E Chmutin  1 , Alexandre V Kim  5 , Dmitri V Hovrin  6 , Dimitri T K Ndandja  1 , Olzhas B Otarov  7 , Hesham M Shaafal  1 , Karina Familia Ramirez  1
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Repeat Discectomy for the Management of Same-Level Recurrent Disc Herniation: A Study of 50 Patients

Gerald Musa et al. Cureus. .

Abstract

Background Same-level recurrent disc herniation remains a challenge in spine surgery. Although most surgeons agree on discectomy as the treatment of choice for primary lumbar disc herniation, the management of recurrent disc herniation remains ambiguous and largely depends on the operating surgeon. Many surgeons recommend repeat discectomy over fusion because it is cheaper and less invasive. In this study, we analyzed 50 patients who underwent a repeat discectomy. Materials and methods The patients in the study had previously been managed for lumbar disc herniation and then presented with either recurrent same-level herniation or symptoms attributed to the same level. The patients were then managed with a repeat discectomy without fusion. We analyzed the preoperative and postoperative Oswestry Disability Index (ODI), duration of surgery, blood loss, duration of hospitalization, and complications. Results Fifty patients were included: 27 females (54%), and 23 males (46%). They were followed up for an average of 2.81 years (range: 1-4). The mean duration of hospitalization was 4.06 ± 1.5 days (range: 2-8). The operative time was 104.60 minutes (range: 50-195), with an intraoperative blood loss of 85.40 mL (range: 50-150 mL). Durotomy occurred as a complication in eight (16%) patients. The recurrence rate was 26%, with 36% progressing to fusion. The change in preoperative ODI and postoperative ODI was 20.94 ± 7.24 (6-37), with a p-value of 0.04. There were no long-term complications recorded. Conclusion Repeat discectomy is a good management option for same-level recurrent disc herniation. The procedure is associated with low intraoperative blood loss and a short operating time, but there is a significant risk of durotomy. The risk of recurrence remains a concern due to the progression of degenerative changes, especially in the presence of Modic-2 changes. These advantages and disadvantages should be discussed with patients.

Keywords: degenerative disc disease; discectomy; modic changes; oswestry disability index (odi); recurrent lumbar disc herniation; spinal instability.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Showing the distribution of intraoperative blood loss.
N: number of patients; Std. dev.: standard deviation.
Figure 2
Figure 2. Showing the duration of surgery.
N: number of patients; Std. Dev: standard deviation.
Figure 3
Figure 3. Showing the percentage of incidental durotomy.
Figure 4
Figure 4. Showing the percentage of patients with recurrence.
Figure 5
Figure 5. Showing the change in preoperative and postoperative Oswestry Disability Index (ODI).
N: number of patients; Std. Dev: standard deviation; ODI Oswestry Disability Index.
See this image and copyright information in PMC

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