Long-term results of disc excision for recurrent lumbar disc herniation with or without posterolateral fusion.

摘要

STUDY DESIGN: A retrospective study assessing the long-term outcomes of repeat surgery for recurrent lumbar disc herniation. OBJECTIVES: To evaluate the results of repeat surgery for recurrent disc herniation, and compare the results of disc excision with and without posterolateral fusion. SUMMARY OF BACKGROUND DATA: The outcomes of revision surgery varied owing to the mixed patient populations. The optimal technique for treating recurrent disc herniation is controversial. METHODS: The sample included 41 patients who underwent disc excision with or without posterolateral fusion, with an average follow-up of 88.7 months (range, 60-134 months). Clinical symptoms were assessed based on the Japanese Orthopedic Association Back Scores. All medical and surgical records were examined and analyzed, including pain-free interval, intraoperative blood loss, length of surgery, and postsurgery hospital stay. RESULTS: Clinical outcome was excellent or good in 80.5% of patients, including 78.3% of patients undergoing a discectomy alone, and 83.3% of patients with posterolateral fusion. The recovery rate was 82.2%, and the difference between the fusion and nonfusion groups was insignificant (P = 0.799). The difference in the postoperative back pain score was also insignificant (P = 0.461). These two groups were not different in terms of age, pain-free interval, and follow-up duration. Intraoperative blood loss, length of surgery, and length of hospitalization were significantly less in patients undergoing discectomy alone than in patients with fusion. CONCLUSIONS: Repeat surgery for recurrent sciatica is effective in cases of true recurrent disc herniation. Disc excision alone is recommended for managing recurrent disc herniation.