Recurrent Intervertebral Disc Research Articles

EPIDEMIOLOGICALRISK FACTORS OF RECURRENCE OF LUMBAR INTERVERTEBRAL DISC HERNIATION AFTER PRIMARY DISCECTOMY (LITERATURE REVIEW)

Primary discectomy for a lumbar intervertebral disc herniated (LDH) is usually accompanied by a rapid regression of clinical symptoms, however, in 5–15 % of cases, an X-ray positive recurrence of the hernia with corresponding orthopedic disorders is registered, which leads to repeated surgical intervention. Objective. Determination of risk factors for recurrence of LDH and their frequency under the conditions of various methods of primary discectomy based on a scientific analysis of the relevant literature. Methods. The material of the research is articles containing the definition of risk factors for the recurrence of a LDH after primary discectomy, for the period 2013–2023 in PubMed, Google Scholar, Medline databases using medical subject headings and keywords «recurrent lumbar disc herniation, surgical interventions, percutaneous endoscopic lumbar discectomy, microdiscectomy, laminectomy, discectomy, spondylodesis». The research method is a systematic review of relevant literature sources. Results. Early and long-term results of primary discectomy for intervertebral disc herniation using decompression (open discectomy, microendoscopic discectomy, percutaneous discectomy, laminectomy, minidiscectomy, endoscopic discectomy) and decompression-stabilization (discectomy combined with spondylodesis) techniques are traced in the literature. The most successful were: 1 year after the operation — endoscopic discectomy (12.4 % of reoperations) and spondylodesis (11.8 %); 10 years after the operation — laminectomy (14 %) and spondylodesis (10 %). The highest rates of revision discectomy: 1 year after the operation — laminectomy (18.6 %); 10 years after surgery — open discectomy and endoscopic discectomy — 16 % each. Conclusions. Recurrent intervertebral disc herniation is an early complication of primary discectomy, the frequency of which varies depending on the surgical technique and the timing of the postoperative period. The most reliable risk factors are male gender, age younger than 50 years, diabetes mellitus, and smoking.

Surgical treatment of recurrent herniated discs of the lumbar spine depending on risk factors

The study included 61 patients with recurrent intervertebral disc herniation. Thirty patients underwent repeated microdiscectomy without transpedicular fixation, 31 patients - resection of recurrent disc herniation with transpedicular fixation (PLIF technique). The control group included 63 patients without recurrent disc herniation. Mean follow-up period was 3.5 years. Discectomy with transpedicular fixation is characterized by larger extent, prolonged surgery time and rehabilitation period. However, there is lower risk of recurrent disc herniation and CSF leakage. Repeated microdisectomy without transpedicular fixation is characterized by smaller extent and shorter surgery time, as well as faster recovery period. Nevertheless, we have higher risk of recurrent disc herniation and CSF leakage. We developed a method for assessing the probability of recurrent intervertebral disc herniation. This algorithm allows us to predict the probability of recurrent disc herniation in a particular patient with 86.7% accuracy. We proposed an algorithm for choosing surgical treatment of recurrent disc herniation. Microdiscectomy without fixation is advisable for the risk of recurrent disc herniation <30%, discectomy with transpedicular fixation - for risk of disc herniation >30%.

Conservative treatment of recurrent intervertebral disc extrusions in a lionhead rabbit

ABSTRACTA 4‐year‐old lionhead rabbit with an acute onset of abnormal hindlimb gait was presented. L4–S3 neurolocalisation was determined based on clinical findings of paraparesis, bilateral proprioceptive positioning deficits, left pelvic limb hyporeflexia and discomfort during lumbar spine manipulation. The magnetic resonance imaging (MRI) revealed an intervertebral disc extrusion (IVDE) at L4–L5, with mild spinal cord compression. The condition was treated conservatively, with cage rest and non‐steroidal anti‐inflammatory drugs. The rabbit was fully normal after 1 month. Two months later, a relapse of clinical signs was observed. A new MRI study revealed a L5–L6 IVDE with mild spinal cord compression. Conservative treatment was repeated and full recovery was confirmed at 4‐month follow‐ups associated with MRI follow‐up study. To the authors' knowledge, this is the first case report of spontaneous IVDEs in a rabbit, where MRI was used to monitor the effectiveness of the conservative management of the disease in a rabbit.

A novel full endoscopic annular repair technique combined with autologous conditioned plasma intradiscal injection: a new safe serial therapeutic model for the treatment of lumbar disc herniation.

Recurrent intervertebral disc herniation and an exacerbated degenerative process have been identified as the most important factors contributing to persistent pain and disability after surgical discectomy. Defects in the annulus fibrosus remain a surgical challenge, as the preference for minimally invasive surgical approaches for lumbar microdiscectomy, surgical access, and the specifics of anatomy limit the types of devices that permit annulus fibrosus repair. Furthermore, the intervertebral disc is a relatively avascular structure, and surgical procedures can accelerate the degenerative disc process. This study aimed to evaluate the clinical safety and efficacy of a novel microdiscectomy annular repair technique combined with an autologous conditioned plasma (ACP) intradiscal injection for the treatment of lumbar disc herniation (LDH). From July 2017 to December 2018 this study recruited 75 patients with LDH (single segment) and randomly divided these patients into the following three groups: group A, full endoscopic discectomy; group B: full endoscopic discectomy and annular repair; group C, full endoscopic discectomy annular repair and ACP intradiscal injection. The pre- and postoperative neurological function and pain status were evaluated by the visual analog scale (VAS) score and the Oswestry disability index (ODI). Patients were followed up once preoperatively, and at 1, 3, and 6 months postoperatively. The procedure was successfully performed in all cases. No cases required conversion to an open procedure. The preoperative symptoms were alleviated significantly after surgery. The VAS scores for lower back and lower limb pain and ODI score were significantly difference at 1 month, 3 months, 6 months post operation compared to pre-operation scores (P<0.05). For VAS scores of the lower back, the difference between group A and group C was statistically significant (A>C), as was the difference between group B and group C (B>C). Early results showed that the use of the novel full endoscopic annular repair technique and ACP intradiscal injection serial therapeutic model are beneficial for short term outcomes and demonstrates a reduction in symptomatic disc reherniation with low postoperative complication rates. This new serial therapeutic model may significantly improve the symptoms of postoperative lower back pain.

Predictive value of ODI, SBI and SF-36 in patients with recurrent lumbar disc herniation undergoing reoperation

To evaluate the predictive value of ODI, SBI and SF-36 in patients with recurrent lumbar disc herniation undergoing reoperation. The patients of recurrent lumbar disc herniation underwent surgical treatment from June 2013 to December 2015 were enrolled in the study. Patients were assigned to A, B, C groups according to the excellent, good, poor of clinical efficacy, and divided into training set and test set by 70:30 ratio according to random number table. we use ordered Logistic regression to construct prediction model, and test set to verify the effect of the model and calculate the accuracy of the model. Both ODI and SBI were lower in group A and group B than group C, and the SF-36 scale was significantly higher than group C (P<0.05). The predictive efficacy model by ordered Logistic regression construction showed that the ODI coefficient was 0.67, the SF-36 coefficient was -0.43, and the SBI coefficient was 0.52. In the group A with excellent clinical efficacy, the prediction accuracy rate of the model was 80%; in the group B with good clinical efficacy, the prediction accuracy rate was 76.92% and in the group C with poor clinical efficacy, the prediction accuracy rate was 44.44%. Comprehensive consideration of ODI, SBI and SF-36 to construct a clinical prediction model for patients with recurrent intervertebral disc herniation after surgery can better predict patients' prognosis. It has a value for clinical application.

Anterior lumbar interbody fusion (ALIF) as an option for recurrent disc herniations: a systematic review and meta-analysis.

Recurrent intervertebral disc herniation is a relatively common occurrence after primary discectomy for lumbar intervertebral disc herniation. For recurrent herniations after repeat discectomies, a growing body of evidence suggests that fusion is effective in appropriately selected cases. Theoretically, anterior lumbar interbody fusion (ALIF) allows for comprehensive discectomy, less trauma to spinal nerves and paraspinal muscles and avoidance of the disadvantages of repeat posterior approaches. However, ALIF has also been associated with risk of vascular injury and retrograde ejaculation. This current systematic review and meta-analysis aims to assess the viability of ALIF as a surgical treatment for recurrent disc herniations. Seven studies were identified from six electronic databases and secondary reference lists. Pre-defined endpoints were extracted from the included studies and meta-analyzed. For the 181 patients from included studies, ALIF resulted in significant average improvements in Oswestry Disability Index (ODI) scores (50.49%, P<0.001), Visual Analogue Scale (VAS) back pain scores (47.85%, P<0.001) and VAS leg pain scores (37.00%, P<0.001). Average blood loss was acceptable at 122 mL (P<0.001) and average operation duration was 89 minutes (P<0.001). Average hospital stay was 5.28 days (P<0.001). Only 22 perioperative complications were reported, with subsidence the most commonly reported complication. Pooled evidence suggests that ALIF is a feasible approach for the treatment of recurrent disc herniations, demonstrating significant improvements in back and leg pain and minimal complications. These findings warrant further investigation in large prospective registries and multi-center studies.

Reoperation for Recurrent Intervertebral Disc Herniation in the Spine Patient Outcomes Research Trial: Analysis of Rate, Risk Factors, and Outcome.

This study was a post-hoc subgroup analysis of prospectively collected data in the Spine Patient Outcomes Research Trial (SPORT). The aim of this study was to determine the risk factors for and to compare the outcomes of patients undergoing revision disc excision surgery in SPORT. Risk factors for reherniation and outcomes after revision surgery have not been well-studied. This information is critical for proper patient counseling and decision-making. Patients who underwent primary discectomy in the SPORT intervertebral disc herniation cohort were analyzed to determine risk factors for undergoing revision surgery. Risk factors for undergoing revision surgery for reherniation were evaluated using univariate and multivariate analysis. Primary outcome measures consisted of Oswestry Disability Index (ODI), the Sciatica Bothersomeness index (SBI), and the Short Form 36 (SF-36) at 6 weeks, 3 months, 6 months, and yearly to 4 years. Of 810 surgical patients, 74 (9.1%) received revision surgery for reherniation. Risk factors for reherniation included: younger age (hazard ratio [HR] 0.96 [0.94-0.99]), lack of a sensory deficit (HR 0.61 [0.37-0.99]) lack of motor deficit (HR 0.54 [0.32-0.91]), and higher baseline ODI score (HR 1.02 [1.01-1.03]). The time-adjusted mean improvement from baseline to 4 years was less for the reherniation group on all outcome measures (Bodily Pain Index [BP] 39.5 vs. 44.9, P = 0.001; Physical Function Index [PF] 37.1 vs. 44.5, P < 0.001; ODI 33.9 vs. 38.3, P < 0.001; SBI 8.7 vs. 10.5, P < 0.001). At 4 years, only SBI (-9 vs. -11.4, P = 0.002) was significantly lower in the reherniation group. Younger patients with higher baseline disability without neurological deficit are at increased risk of undergoing revision surgery for reherniation. Those considering revision surgery for reherniation will likely improve significantly following surgery, but possibly not as much as with primary discectomy. 3.

A combined biomaterial and cellular approach for annulus fibrosus rupture repair

Recurrent intervertebral disc (IVD) herniation and degenerative disc disease have been identified as the most important factors contributing to persistent pain and disability after surgical discectomy. An annulus fibrosus (AF) closure device that provides immediate closure of the AF rupture, restores disc height, reduces further disc degeneration and enhances self-repair capacities is an unmet clinical need. In this study, a poly(trimethylene carbonate) (PTMC) scaffold seeded with human bone marrow derived mesenchymal stromal cells (MSCs) and covered with a poly(ester-urethane) (PU) membrane was assessed for AF rupture repair in a bovine organ culture annulotomy model under dynamic load for 14 days. PTMC scaffolds combined with the sutured PU membrane restored disc height of annulotomized discs and prevented herniation of nucleus pulposus (NP) tissue. Implanted MSCs showed an up-regulated gene expression of type V collagen, a potential AF marker, indicating in situ differentiation capability. Furthermore, MSCs delivered within PTMC scaffolds induced an up-regulation of anabolic gene expression and down-regulation of catabolic gene expression in adjacent native disc tissue. In conclusion, the combined biomaterial and cellular approach has the potential to hinder herniation of NP tissue, stabilize disc height, and positively modulate cell phenotype of native disc tissue.

Obesity and recurrent intervertebral disc prolapse after lumbar microdiscectomy.

The primary aim of this study was to investigate the relationship between obesity and recurrent intervertebral disc prolapse (IDP) following lumbar microdiscectomy. A retrospective review of case notes from 2008 to 2012 was conducted for all patients who underwent single level lumbar microdiscectomy performed by a single surgeon. All patients were followed up at two weeks and six weeks following surgery, and given an open appointment for a further six months. A total of 283 patients were available for analysis: 190 (67%) were in the non-obese group and 93 (32.9%) in the obese group. There was no statistical difference in postoperative infection, dural tear or length of stay between the non-obese and obese groups. Recurrent symptomatic IDP was seen in 27 patients (9.5%) confirmed by magnetic resonance imaging. Nineteen (10.0%) were in the non-obese group and eight (8.6%) in the obese group (p>0.8). In our study, obesity was not a predictor of recurrent IDP following lumbar microdiscectomy. Our literature review confirmed that this study reports the largest series to date analysing the relationship between obesity and recurrent IDP following lumbar microdiscectomy in the British population.

Agreement between magnetic resonance imaging, myelography, and surgery for detecting recurrent, thoracolumbar intervertebral disc extrusion in dogs

Although magnetic resonance imaging (MRI) is reported to be superior to myelography to determine the location and site of first time disc herniation, comparison of these diagnostic methods in cases of recurrent intervertebral disc disease (IVD) herniation after a first surgery has not been evaluated. The objective was to compare the diagnostic accuracy of MRI and myelography in a series of dogs undergoing repeat surgical decompression for recurrent IVD extrusion when compared to the gold standard of surgery. Ten dogs with recurrent IVD herniation underwent MRI and myelography followed by surgical decompression. Three observers reviewed the images to determine the site and side of the first surgery and the recurrent lesion. Agreement was determined by calculating a kappa (κ) score. Substantial interobserver agreement was noted for recurrent lesion site using MRI and myelography (κ = 0.77 vs. 0.73) and when comparing MRI and myelography to the reported surgical site (κ = 0.73 vs. 0.67). Interobserver agreement was greater with MRI for circumferential location compared to myelography (κ = 0.76 vs. 0.43), similar to what was found when comparing to surgical side (κ = 0.82 vs. 0.49). The previous surgical site in this study had no effect on ability to identify the new lesion. Despite the limitations of MRI, there was greater agreement between observers using MRI for both the recurrent and first lesion.

Revisional lumbar microdiscectomy: an analysis of operative findings and clinical outcome

Forty-one consecutive patients who underwent a revision microlumbar exploration for recurrent or persistent sciatica were reviewed retrospectively to analyse the operative findings and assess the clinical outcome following surgery. Thirty-three (80%) patients were found to have a recurrent intervertebral disc protrusion at the previous site, two patients had a disc herniation at a new site, one had severe perineural scarring, two had lateral recess stenosis, one patient had undergone previous exploration at an incorrect site and in two patients no cause for ongoing symptoms was found. Nineteen of the 33 patients with a re-prolapse presented with persistent or recurrent sciatica within 1 year of their first operation. The other 14 patients presented with a late re-prolapse (after 1 year) and their clinical outcome was better than for those patients with an early re-prolapse (12/14 vs 11/19 satisfactory result, respectively). The result of operating on patients with a late re-prolapse was comparable to the 80-95% satisfactory outcomes following primary lumbar microdiscectomy reported by other authors.

The lumbar shield: a progress report.

The lumbar shield is a silicone implant designed to prevent postoperative perineural adhesions, indicate a recurrent intervertebral disc rupture, facilitate further surgery at that level, and aid in the postoperative management of the patient. Over three years it has been implanted in 123 experimental patients. There are 83 control patients. Statistical analysis of the results indicates that for the first three months, those patients with the lumbar shield had less postoperative pain. The diagnosis of a recurrent lumbar disc rupture on lateral lumbar spine radiographs is illustrated. The ease of secondary surgery for a recurrent lumbar disc rupture is emphasized. The value of the lumbar shield in postoperative management is discussed, especially in the workmen's compensation/medicolegal groups. One conclusion is that the frequency of multiple secondary surgical procedures on patients with unsatisfactory initial results could be reduced by the use of the lumbar shield.