New Approaches to Surgical Treatment of Recurrent Lumbar Intervertebral Disc Herniation

Abstract

Objective. To assess feasibility of the proposed anterior decompression and stabilization surgery without meningoradicu- lolysis for recurrent herniation of the lumbar intervertebral disc. Material and Methods. Prospective randomized controlled study involved comparative evaluation of two essentially different surgical interventions performed in 130 patients with recurrent disc herniation in 2005–2012. The control group included 62 patients who underwent posterior decompression and stabilization surgery with meningoradiculolysis to re- move the herniated disc. The study group included 68 patients who underwent the proposed anterior decompression and stabilization surgery, which differs by an obligate opening of the spinal canal and intervertebral foramen to remove the disc herniation through an anterior approach without meningoradiculolysis. Results. Immediate results of anterior and posterior decompression and stabilization operations are comparable, though posterior interventions are more frequently associated with iatrogenic injury to posterior nerve roots caused by intervertebral implant insertion and meningoradiculolysis required before the disc herniation removal. Long-term outcomes of anterior operations are reliably better. Conclusion. Anterior decompression and stabilization operations for recurrent disc herniation compare favorably to posterior ones, since they are less traumatizing to the nerve roots and prevent herniation recurrence and epidural fibrosis progression.

Keywords

• surgical treatment
• recurrence of disc herniation