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04.11.2017 | Treatment of Lumbar Degenerative Pathology (HJ Kim and G Mundis, section editors) | Ausgabe 4/2017

Current Reviews in Musculoskeletal Medicine 4/2017

Treatment for Recurrent Lumbar Disc Herniation

Zeitschrift:
Current Reviews in Musculoskeletal Medicine > Ausgabe 4/2017
Autoren:
Randall J. Hlubek, Gregory M. Mundis Jr.
Wichtige Hinweise
This article is part of the Topical Collection on Treatment of Lumbar Degenerative Pathology

Abstract

Purpose of Review

Recurrent lumbar disc herniation (RLDH) is the most common indication for reoperation after a lumbar discectomy. The purpose of this manuscript is to review the incidence, risk factors, and treatment for RLDH.

Recent Findings

Patients who require revision surgery for RLDH improved significantly compared to baseline; however, the magnitude of improvement is less than in primary discectomy patients. Treatment with either repeat discectomy or instrumented fusion has comparable clinical outcomes. Repeat discectomy patients, however, have shorter operative times and length of stay. Hospital charges are dramatically lower for repeat discectomy compared to instrumented fusion.

Summary

The incidence of RLDH is somewhere between 5 and 18%. Risk factors include younger age, lack of a sensory or motor deficit, and a higher baseline Oswestry Disability Index (ODI) score. Available evidence suggests that some patients may respond to nonoperative interventions and avoid the need for reoperation. For those that fail a trial of conservative management or present with neurologic deficit, both repeat lumbar discectomy and instrumented fusion appear to effectively treat patients with similar complication rates and clinical outcomes.

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