Long-term outcome of redo discectomy for recurrent lumbar disc herniations

Abstract

Purpose: Recurrent lumbar disc herniation (RLDH) is an important cause of morbidity, loss of quality of life and healthcare costs. The goal of this investigation is to assess surgical outcomes and their predictors in patients who underwent revision discectomy for RLDH, with a minimum follow-up of ten years, to shed light on the best treatment to offer to these patients. Methods: Patients who underwent revision discectomy to treat RLDH between 2004 and 2011 in our Department were enrolled. Demographic, clinical, and surgical data were collected. The need of third intervention for RLDH was the primary outcome. Patient's satisfaction, Core Outcome Measures Index, Oswestry Disability Index, and EuroQoL-5D scores were also evaluated. Results: This study includes 57 patients, with a mean follow-up time of 143 months [114 -199]. In this period, a third intervention was needed in 29.8% (n=17) of patients. Most recurrences took place in the first 2 years after the second surgery (58.8%, n=10) and the risk of needing a third surgery decreased over time. After 5 years, the probability of not having surgery for recurrence was 72% [CI 95%: 61-85%], with a tendency to stabilize after that. An interval between the first discectomy and the surgery for recurrence shorter than 7.6 months was identified as a predictor for a second recurrence. Conclusion: The risk of needing a third surgery seems to stabilize after five years. Patients with an early recurrence after the first discectomy seem to have a higher risk of a new recurrence, so an arthrodesis might be worth considering.