Reoperation after herniated disc removal in patients with lumbar degenerative disc disease

Abstract

Objective. To analyze the reasons for and to evaluate the results of repeated surgery in patients with lumbar degenerative disc disease af- ter the removal of herniated discs. Material and Methods. The results of surgical treatment in 186 patients (mean age 48.7 years) treated between 2013 and 2014 at the Federal Center for Neurosurgery in Novosibirsk were analyzed. All patients previously underwent surgery for lumbar disc herniation in different hospitals. Primary intervention at one level was performed in 171 patients (92.0 %), and at two levels – in 15 patients (8.0 %). Results. Progression of degeneration at the operated segment was detected in 155 patients (83.3 %). Out of them, recurrent disk hernia- tion was diagnosed in 92 patients (49.5 %) and instability at the operated level was found in 63 patients (33.8 %). Adjacent segment de- generation was diagnosed in 31 patients (16.7 %). After surgery, positive results in pain regression were achieved in 87.1 % of cases, and unsatisfactory results with preserved pain intensity were observed in 12.9 %. Conclusion: The main causes of reoperation after primary microdiscectomy were recurrent disc herniation and instability of the operated segment. In 16.7 % of cases, repeated surgery was performed for the adjacent segment degeneration, which must be regarded as a sequela of primary disease. The use of differential surgical treatment strategy based on the identification of the dominant clinical and neurological syndrome provides good and satisfactory results in patients undergoing reoperation after primary microdiscectomy.

Keywords

• recurrent disc herniation
• adjacent segment degeneration
• modic classification