Standard Single Level discectomy; Evaluation of the Risk Factors for Recurrence

Abstract

Background Data: Various surgical options exist for lumbar disc herniation. In patients who do not respond to conservative treatment, open discectomy still remains a standard method and it has been reported to have diverse outcomes. Despite a high early success rate with lumbar discectomy procedures, variable long-term results and worsening or recurrence of the patient’s condition overtime have been reported. Purpose: To evaluate the risk factors for recurrence of disc disease in relation to disc pathology, age, and activities. Study Design: A retrospective clinical Case review.Patients and Methods: One hundred twenty patients who had undergone standard discectomy for lumbar disc herniation were studied. All had single level disc herniation. Patients with spondylolysis, spondylolisthesis, or spinal stenosiswere excluded. Indications of surgery were severe radiculopathy of at least two month duration, unresponsive to conservative treatment or neural deficit. A preoperative diagnosis of lumbar disc herniation was based on symptoms, physical examination and MRI findings. A total of 7 patients (6%) were confirmed as having recurrence of disc herniation.Results: All of our 7 patients were in age group of 20-40 years. The recurrence occurred in 2 patients out of 7 through the 1st 5 years after surgery. Most of recurrent patients (5 patients, 71%) had originally a contained disc herniation,2 patients (29%) had originally a protruded discs and none had originally a sequestrated discs. Recurrence in L4-5 level was in 5 patients (71%) while in L5- S1 in 2 cases (29%). Conclusion: The risk of recurrence of disc herniation after open discectomy was higher in young, active men. The recurrence rate of disc herniation increased with time after surgery. Recurrence rate was higher for patients with contained herniation than other types. (2013ESJ043)