Abstract

Background: Recurrent disc herniations remain a challenge in spinal surgery. Although some authors recommend a repeat discectomy, others offer more invasive secondary fusions. Here, we reviewed the literature (2017–2022) regarding the safety/efficacy of treating recurrent disc herniations with repeated discectomy alone.

Methods: Our literature search of recurrent lumbar disc herniations included; Medline, PubMed, Google scholar, and the Cochrane database. We focused on the types of discectomy performed, perioperative morbidity, costs, length of surgery, pain scores, and incidence of secondary dural tears.

Results: We identified 769 cases that included 126 microdiscectomies, and 643 endoscopic discectomies. Rates of disc recurrence ranged from 1% to 25% with accompanying secondary durotomy varying from 2% to 15%. In addition, operative times were relatively short, ranging from 29.2 min to 125 min, with a relatively small average estimated blood loss (i.e., minimal to maximally 150 mls).

Conclusion: Repeated discectomy was the most commonly performed treatment for same-level recurrent disc herniations. Despite minimal intraoperative blood loss and short operating times, there was a significant risk of durotomy. Notably, patients must be informed that more extensive bone removal for treating recurrent disc increases the risk for instability warranting subsequent fusion.

Keywords: Degenerative disc disease, Disc herniation, Recurrent herniation, Spinal instability

INTRODUCTION

The optimal management of recurrent lumbar disc herniations (incidence 10–30%) remains controversial. The multiple discectomy methods include; routine open diskectomy, microdiscectomy and endoscopic discectomy.[ 1 , 8 ] Although repeat discectomy alone has several advantages (i.e., less invasive, shorter hospital stay, and reduced cost), a subset of up to 25% of these patients may later develop instability warranting fusions.[ 2 , 6 , 9 ] Here, we reviewed the literature over the past 5 years for treating recurrent lumbar discs with repeated diskectomy alone.

MATERIALS AND METHODS

A non-systematic MEDLINE search for the literature (2017–2022) was performed on Google Scholar, clinical trials, and PubMed using the keywords “discectomy for recurrent herniation,” “recurrent disc herniation”, “repeat discectomy”, and “re-herniation management.” Articles had to include more than ten patients who underwent discectomy for recurrent disc herniations. Variables studied included; demographic, clinical, surgical, and outcome data (i.e., including postoperative complications, and disc recurrence rates). There were also multiple exclusions [ Table 1 ].

Table 1:

A summary the reviewed articles and collected data.

RESULTS

The ten studies included 769 patients, who underwent; 126 microdiscectomies and 643 endoscopic discectomies (i.e., 269 microscope assisted endoscopic discectomy and 200 full endoscopic interlaminar endoscopy) [ Table 2 ]. No patients had open discectomy. The disc recurrence rate ranged from 1% to 25%, and the most common complication was durotomy (2–15%) [ Table 3 ]. Operative times and blood loss were also measured [ Table 4 ].

Table 2:

The demographic data and the type of discectomy performed.

Table 3:

The rates of durotomy and recurrence following repeat discectomy.

Table 4:

The operative time and intraoperative blood loss.

DISCUSSION

The major options for treating recurrent lumbar disc herniations (rates ranging from 2.4 to 25%), include open procedures, microdiskectomies, or endoscopic approaches.[ 4 , 5 , 8 ] These repeat surgeries require variable operative times (i.e., range 29 min to 113.3 ± 45.44 min) and usually incur significant additional risks due to scar, including intraoperative durotomy (2%[ 3 ] to 15%), and hemorrhage.[ 3 , 10 ] An estimated 25% of patient who present with recurrent discs already exhibit instability, warranting consideration of simultaneous fusion that could increase perioperative morbidity and costs.[ 4 , 7 ]

CONCLUSION

Recurrent lumbar disc herniations may be managed with repeat diskectomy without fusion. Nevertheless, repeat diskectomies alone, although minimizing blood loss and operative times, typically require greater bone removal to adequately expose recurrent disc fragments increases the risk of postoperative instability.

Declaration of patient consent

Patient’s consent not required as there are no patients in this study.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

Disclaimer

The views and opinions expressed in this article are those of the authors and do not necessarily reflect the official policy or position of the Journal or its management. The information contained in this article should not be considered to be medical advice; patients should consult their own physicians for advice as to their specific medical needs.

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