Open Access, Peer-reviewed
pISSN 2093-4378
eISSN 2093-4386
    J Korean Soc Spine Surg. 2007 Sep;14(3):151-157. Korean.
    Published online Sep 30, 2007.
    https://doi.org/10.4184/jkss.2007.14.3.151
    Copyright © 2007 Korean Society of Spine Surgery
    Original Article

    Treatment Outcome of Reoperative Lumbar Disc Herniation

    Kyu-Yeol Lee, M.D., Sung-Keun Shon, M.D., Myung-Jin Lee, M.D. and Lih Wang, M.D.
      • Department of Orthopaedic Surgery, College of Medicine, Dong-A University, Busan, Korea.
    • Address reprint requests to: Kyu-Yeol Lee, M.D. Department of Orthopedic Surgery, College of Medicine, Dong-A University, 3-1 Dongdaesin-Dong, Seo-Gu, Busan, 602-715, Korea. Tel: 82-51-240-2867, Fax: 82-51-243-9764, Email: gylee@dau.ac.kr

    Abstract

    Study Design

    A retrospective study.

    Objectives

    To analyze the causes and treatment outcomes of reoperation after a lumbar discectomy.

    Summary of the Literature Review

    The major causes of reoperation after a lumbar disc surgery is recurrent disc herniation. Satisfactory outcomes can be obtained with reoperation for patients still requiring treatment.

    Materials and Methods

    Fifty two patients, who had undergone reoperations after lumbar discectomies with a minimum follow-up period of one year, were reviewed. The causes of the reoperation were analyzed according to the physical examination and conventional radiographic evaluation. The surgical outcome was assessed using the JOA score and Kirkaldy-Willis criteria, and the recovery rate was calculated according to the JOA score. Statistical analysis was carried out to evaluate the factors that might influence the outcome of reoperation.

    Results

    The causes of reoperation after lumbar disc surgery included 46 cases of recurrent disc herniation, each two cases of the wrong level, spinal canal stenosis and lumbar instability. The average JOA score increased from 11 to 24, and the average recovery rate was approximately 72%. According to the Kirkaldy-Willis criteria, the results were excellent and good in approximately 85% of cases. Statistical analysis revealed that the factors associated with a successful outcome were a single previous surgical procedure (p<0.02), a preoperative JOA score over 10 points (p<0.01), and a pain-free interval of more than 12 months after the previous operation(p<0.01).

    Conclusion

    The treatment outcomes of reoperative lumbar disc herniation were satisfactory. Factors, such as the low number of prior procedures, high preoperative JOA score, and long pain-free interval after a previous operation, can lead to a successful treatment outcome of reoperation.

    Keywords
    Reoperation; Lumbar disc herniation; Treatment outcome

    Figures

    Fig. 1
    54 year-old male patients. (A) Preoperative Magnetic Resonance image shows L4-5 lateral recess type of stenosis in previous discectomy level. (B) Posterior decompression and posterolateral fusion was done. JOA score increased to 7 to 19, with the recovery rate of 54.5%. Finally, clinical result was fail according to the Kirkaldy-Willis criteria.

    Fig. 2
    43 year-old male patient. (A) Preoperative radiographs shows isthmic defect with instability in previous discectomy level at L4-5. (B) Posterior decompression and posterolateral fusion was done. JOA score increased to 10 to 25, with the recovery rate of 78.9%. End result was good according to the Kirkaldy-Willis criteria.

    Fig. 3
    28 year-old female patient. (A) T2-weight axial MR image shows right-sided extrusion of the L4-5 disc. (B) MR image shows left-sided disc extrusion of the recurrent disc at the same level. Open laminectomy and discectomy was done. JOA score increased to 13 to 25, with the recovery rate of 75%. End result was good according to the Kirkaldy-Willis criteria.

    Tables

    Table 1
    Summary of the patients' average characteristic related to diagnosis

    Table 2
    Operative outcome related to diagnostic subgroup

    Table 3
    Relationship of patient and operative values with respect to the success or failure of the reoperation

    References

      1. Andrews DW, Lavyne MH. Retrospective analysis of microsurgical and standard lumbar discectomy. Spine 1990;15:329–335.
      1. Barrios C, Ahmed M, Arrotegui J, Bjornsson A, Gillstrom P. Microsurgery versus standard removal of the herniated lumbar disc. Acta Orthop scand 1990;61:339–403.
      1. Dvorak J, Gauchat MH, Valach L. The outcome of surgery for lumbar disc herniation. A 4-17 years' follow-up with emphasis on somatic aspects. Spine 1998;13:1418–1422.
      1. Eismont FJ, Currier B. Surgical management of lumbar intervertebral disc disease. J bone joint surg Am 1989;71:1266–1271.
      1. Kahanovitz N, Viola K, McCulloch J. Limited surgical discectomy and microdiscectomy. A clinical comparison. Spine 1989;14:79–81.
      1. Weber H. Lumbar disc herniation. A controlled, prospective study with 10 years of observation. Spine 1983;8:131–140.
      1. Bernard TN. Repeat lumbar spine surgery. Factors influencing outcome. Spine 1993;18:2196–2200.
      1. Brinckmann P, Grootenboer H. Change of disc height, radial disc bulge, and intradiscal pressure from disectomy. An in vitro investigation on human lumbar discs. Spine 1991;16:641–646.
      1. Fandino J, Botana C, Viladrich A, Gomez-Bueno J. Reoperation after lumar disc surgery: Results in 130 cases. Acta Neurochir 1993;122:102–104.
      1. Greenwood J, McGuire TH, Kimbel EF. A study of the causes of failure in the herniated intervetebral disc operation. J Neuosurg 1952;9:15–20.
      1. Kim SS, Michelsan CB. Revision surgery for failed back surgery. Spine 1992;17:957–960.
      1. Ashok B, Steven PH, Gunnar BJA. Lumbar disc disease. In: Rothman-Simeone, editor. The spine. 5th ed. Philadelphia: W.B. Saunders Co; 2006. pp. 930-944.
      1. Mixter WJ, Barr JA. Rupture of the intervertebral disc with involvement of the spinal cord. New engl J Med 1934;211:210–215.
      1. O'sullivam MG, Commolly AE, Buckley TF. Recurrent lumbar disc protrusion. Br J Neurosur 1990;4:319–325.
      1. Pappas CTE, Harrinton T, Sonntaf VKH. Outcome analysis in 654 surgically treated lumbar disc herniation. Neurosurgery 1992;30:862–866.
      1. Rish BL. A critique of the surgical management of lumbar disease in a private neurological practice. Spine 1984;9:500–504.
      1. Spanfort EV. The lumbar disc herniaiton, A computer-aided analysis 2,504 operations. Acta Orthop Scand Suppl 1972;142:1–95.
      1. Amstrong JR. The causes of unsatisfactory results from the operative treatment of lumbar disc lesion. J bone joint surg Br 1951;33:31–35.
      1. Fager CA, Friedberg SR. Analysis of failure and poor results of lumbar spine surgery. Spine 1980;5:87–94.
      1. Ford LT. Postoperative infection of intervertebral disc space. South Med J 1955;48:1295–1303.
      1. Spengler DM. Lumbar discectomy. Results with limited disc excison and selective foraminotomy. Spine 1982;7:604–607.
      1. Quimjian JD, Matrka PJ. Decompression laminectomy and lateral spinal fusion in patients with previously failed spine surgery. Orthopedics 1988;11:563–569.
      1. O'sullivan MG, Commolly AE, Buckley TF. Recurrent lumbar disc protrusion. Br J Neurosur 1990;4:319–325.
      1. Cinotti G, Roysam GS, Eisenstein SM, Postacchini F. Ipsilateral recurrent lumbar disc herniation, A prospective controlled study. J Bone Joint Surg Br 1998;80:825–832.
      1. Williams RW. Microlumbar discectomy: A conservative surgical approach to the virgin herniated lumbar disc. Spine 1978;3:175–182.
      1. Ethier DB, Cain JC, Yaszemski MJ, et al. The influence of anulotomy selection on disc competence. Spine 1994;19:2071–2076.
      1. Wiesel SW. The multiply operated lumbar spine. Instructional Course Lecture. AAOS Meeting; 1985. pp. 68-77.
      1. Finnegan WJ, Fenlin FM, Marvel JP, Nardini RJ, Rothman GH. Results of surgical intervention in the symptomatic multiply operated back patient. J Bone Joint surg Am 1979;61:1077–1082.
      1. Waddell G, Kummel EG, McCulloch HA. Failed lumbar disc surgery and repeated surgery following industrial injuries. J bong Joint surg Am 1979;61:201–207.
      1. Pheasan HC. Source of failure in laminectomies. Orthop clin N Am 1975;6:319–330.
      1. Dai LY, Zhou Q, Yao WF, Shen L. Recurrent lumbar disc herniation after discectomy: Outcome of repeat discectomy. Surg Neurol 2005;64:226–231.
      1. Jackson RK. The long-term effects of wide laminectomy for lumbar disc excision, A review of 130 patients. J Bone Joint surg Br 1971;53:609–616.
    MeSH Terms
    Constriction, Pathologic
    Diskectomy
    Follow-Up Studies
    Humans
    Physical Examination
    Reoperation
    Retrospective Studies
    Spinal Canal
    Treatment Outcome*
    Metrics
    Share
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    Tables
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