Abstract
ObjectiveRecurrent lumbar disc herniation (LDH) is the most frequent reason for reoperation after lumbar microdiscectomy. While several risk factors for recurrent LDH have been well-described, the effect of age on recurrence remains unclear, especially concerning the timing of recurrent LDH.MethodsFrom a prospective registry, we identified all patients who underwent tubular microdiscectomy for LDH. Recurrent LDH was defined as reoperation for LDH at the same index level and side. The associations among age and incidence of recurrent LDH as well as on time to recurrent LDH were statistically evaluated using multivariable analysis of covariance, linear regression, and Cox proportional hazards modelling.ResultsOf the 3013 patients who underwent surgery for LDH, 166 (5.5%) had to undergo reoperation due to LDH recurrence. Uni- and multivariable analysis revealed no influence of age on the incidence of recurrent LDH (both p > 0.05). Linear regression indicated earlier reoperation in older patients, both with (β = −0.248) and without (β = −0.374) correction for confounders (both p < 0.05). An additional survival analysis found that patients aged over 35 years had recurrent LDH significantly earlier (hazard ratio 0.617, p = 0.013).ConclusionIn an analysis of a large prospective database of patients undergoing microdiscectomy for lumbar disc herniation, we found that younger patients do not have a higher reoperation probability than their older counterparts, even after correcting for multiple confounders. However, older patients tend to experience recurrent LDH significantly earlier after the index surgery compared to younger patients.
Highlights
Lumbar disc herniation (LDH) is one of the most common indications for lumbar spine surgery [1]
4 Neurosurgery, Amsterdam Movement Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands more common in lumbar neurosurgery, the current literature suggests that 3 to 13% of all patients undergo redo surgery because of a LDH recurrence [2,3,4,5,6]. It is important for both physicians and patients to identify risk factors for LDH recurrence, so that optimized individual pre- and postoperative patient management may lead to a lower occurrence
This study is a result of a clinical hypothesis generated by the surgeon’s observation that LDH recurrence is more common in younger patients, but that LDH recurrence occurs significantly earlier in older patients compared to their
Summary
Lumbar disc herniation (LDH) is one of the most common indications for lumbar spine surgery [1]. Minimally invasive surgical techniques are becoming more and. As a result, it is important for both physicians and patients to identify risk factors for LDH recurrence, so that optimized individual pre- and postoperative patient management may lead to a lower occurrence. This study is a result of a clinical hypothesis generated by the surgeon’s observation that LDH recurrence is more common in younger patients, but that LDH recurrence occurs significantly earlier in older patients compared to their. The first part of this hypothesis is further corroborated by a review conducted by Hlubek et Mundis in 2017 [6], in which younger age is stated as risk factor for LDH recurrence. On the other hand many other studies suggest an absent [5, 7, 9,10,11] or even a reversed [12] effect of age on LDH recurrence
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