Abstract
PurposeRecurrent lumbar disk herniation (rLDH) following lumbar microdiscectomy is common. While several risk factors for primary LDH have been described, risk factors for rLDH have only sparsely been investigated. We evaluate the effect of Body mass index (BMI) and smoking on the incidence and timing of rLDH.MethodsFrom a prospective registry, we identified all patients undergoing primary tubular microdiscectomy (tMD), with complete BMI and smoking data, and a minimum 12-month follow-up. We defined rLDH as reherniation at the same level and side requiring surgery. Overweight was defined as BMI > 25, and obesity as BMI > 30. Intergroup comparisons and age- and gender-adjusted multivariable regression were carried out. We conducted a survival analysis to assess the influence of BMI and smoking on time to reoperation.ResultsOf 3012 patients, 166 (5.5%) underwent re-microdiscectomy for rLDH. Smokers were reoperated more frequently (6.4% vs. 4.0%, p = 0.007). Similarly, rLDH was more frequent in obese (7.5%) and overweight (5.9%) than in normal-weight patients (3.3%, p = 0.017). Overweight smokers had the highest rLDH rate (7.6%). This effect of smoking (Odds ratio: 1.63, 96% CI: 1.12–2.36, p = 0.010) and BMI (Odds ratio: 1.09, 95% CI: 1.02–1.17, p = 0.010) persisted after controlling for age and gender. Survival analysis demonstrated that rLDH did not occur earlier in overweight patients and/or smokers.ConclusionsBMI and smoking may directly contribute to a higher risk of rLDH, but do not accelerate rLDH development. Smoking cessation and weight loss in overweight or obese patients ought to be recommended with discectomy to reduce the risk for rLDH.
Highlights
Sciatica due to lumbar disk herniation (LDH) represents one of the most frequent indications for lumbar spine surgery [1]
We evaluate the effect of Body mass index (BMI) and smoking on the incidence and timing of recurrent LDH (rLDH) after microdiscectomy
The incidence of reoperation for rLDH was higher in overweight (5.9%) and obese (7.5%) patients compared to normal-weight patients (3.3%, p = 0.017, Fig. 2)
Summary
Sciatica due to lumbar disk herniation (LDH) represents one of the most frequent indications for lumbar spine surgery [1]. While patient satisfaction and rates of improvement in pain and functional impairment are usually very high after microdiscectomy, reoperations due to recurrent LDH (rLDH) are not uncommon, with incidences ranging between 2 and 11% [2,3,4,5,6,7,8]. Reoperations for rLDH can incur high direct and indirect health care-associated costs, as well as additional complications and morbidity [6, 7, 9]. While risk factors for primary LDH have been relatively well-established, the literature is rather sparse on risk factors for rLDH. Several studies have investigated risk factors or potential etiologies for rLDH, with often inconsistent results, low statistical power, or low effect sizes for certain potential risk factors [3, 7, 10,11,12,13,14]. Knowledge of robust risk factors for reherniation with a clinically relevant
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