Recurrence of backache following discectomy: An analysis of management.

Abstract

Abstract Background Data: Intervertebral disc prolapse, being one of the most common spine problems in the industrialized world, has a lot of medical, social, legal, and economic implications following the recurrence of pain following surgery. Due to variability in the causes of the pain generators, it is hard to devise a definitive treatment plan. However, the threshold for conservative and surgical management needs to be understood. Purpose: The study was conducted to find out the causes for recurrence of backache following lumbar discectomy and to evaluate the effect of conservative management. The number of patients requiring a second surgery, the causes, and the effects of the second surgery on the patients were analyzed. Study Design: Observational analytic prospective study Patients and Methods: Thirty-one consecutive patients who presented with recurrence or persistence of backache between September 2016 and September 2017 following lumbar discectomy at our centre were evaluated. These patients were examined clinically and underwent evaluation in the form of blood investigations, plain radiographs, and MRI (Magnetic Resonance Imaging) as per protocol and further management was decided accordingly. Patients who underwent surgical and conservative management were followed up separately at of 1, 6, and 12 months and evaluated using SLR (Straight Leg Raising), ODI (Oswestry Disability Index), and VAS (Visual Analogue score). Results: Patients were in the age range of 28–66 years and the male/female ratio was 1.8:1. The operated level that presented most with recurrence was L4-L5. Repeat prolapse was the most common cause of recurrence. Twenty-three out of 31 patients responded to conservative management and 8 patients required surgery. The mean SLR, VAS, and ODI scores improved significantly by conservative methods. Furthermore, these scores improved significantly by surgery, but the rate and the sustenance of improvement varied in the two groups. Conclusion: Most of the patients responded well to conservative management following recurrence except for cases who had absolute indications for surgery such as infection, pseudomeningocele, or re-herniation with severe compression. The common causes ofrecurrence of symptoms varied according to the primary surgery done (laminectomy/fenestration). Outcomes of both conservative and surgical management were good at the end of 1 year. (2020ESJ206)   Background: Intervertebral disc prolapse, being one of the most common problems in the industrialized world, has a lot of medical, social, legal and economic implications following recurrence of pain following surgery. Due to variability in the causes of the pain generators, a definitive treatment plan is hard to devise. However the threshold for conservative and surgical management needs to be understood. Purpose: The study was done to find out the causes for recurrence of backache following discectomy in our centre along with patient demographics and evaluate the effect of conservative management on them. The number of patients requiring a second surgery, the causes for them and the effect of second surgery on the patient also needed to be analyzed. Study Design: Observational analytic prospective study Methodology: Thirty one consecutive patients who presented between September 2016 and September 2017 with recurrence or persistence of backache following discectomy at our centre were evaluated. These patients were examined clinically and underwent evaluation in the form of blood investigations, radiographs and MRI (Magnetic Resonance Imaging) as per protocol and further management was decided accordingly. Patients who underwent surgical and conservative management were followed up seperately at intervals of 1, 6 and 12 months and evaluated using SLR (Straight Leg Raising), ODI( Oswestry Disability Index) and VAS (Visual Analogue score). Results: Patients were in the age range of 28-66 years and the male:female ratio was 1.8:1. Operated L4-L5 level presented most commonly with recurrence. Repeat prolapse was the most common cause for recurrence. 23 out of 31 patients responded to conservative management and 8 patients required surgery. The mean SLR, VAS scores and ODI scores were noted to have improved significantly by conservative methods. These scores improved significantly by surgery too but the rate and sustainance of improvement varied in the two methods. Conclusion: Most of the patients responded well to conservative management post recurrence except for cases which had absolute indications for surgery such as infection, pseudomeningocele or reherniation with severe compression. The common causes of recurrence of symptoms varied according to the surgery done (laminectomy / fenestration). Outcome of both conservative and surgical management were good at the end of 1 year.