Recurrent Lumbar Disc Herniation: A Narrative Review

Abstract

This narrative review aimed to identify various risk factors of recurrent lumbar disc herniation (rLDH) post-discectomy and its management. The rLDH has remained a challenging problem for spine surgeons. The incidence of rLDH is reported widely from 1% to 21%. Many possible patient-related, disc-related, and surgery-related risk factors may predispose the patient to rLDH. Moreover, the clinical and radiological diagnosis of rLDH can be challenging. Once the diagnosis is confirmed, and alternative diagnoses for leg pain have been ruled out, a course of initial non-operative treatment can be attempted. Compared to primary LDH, non-operative treatment is less likely to succeed in rLDH, possibly due to the associated epidural fibrosis and scarring. Various surgical options can be considered, including revision discectomy and fusion. Revision discectomy is usually the primary choice of surgery for the first recurrence. A fusion procedure can be chosen for those who have repeated reherniations or significant associated back pain. Precise patient selection is a must to achieve excellent surgical outcomes. Keywords: Lumbar disc herniation, recurrent herniation, discectomy, risk factor, Epidural fibrosis, narrative review.