International Orthopaedics

, Volume 37, Issue 8, pp 1511–1517 | Cite as

Reoperation after lumbar disc surgery in two hundred and seven patients

  • Jiwei Cheng
  • Hongwei WangEmail author
  • Wenjie Zheng
  • Changqing Li
  • Jian Wang
  • Zhengfeng Zhang
  • Bo Huang
  • Yue ZhouEmail author
Original Paper



The purpose of this study was to compare the causes and characteristics of reoperations after different primary operations for lumbar disc herniation (LDH).


Out of a series of 5,280 patients who underwent operations for LDH between 2001 and 2012, 207 patients (135 male and 72 female, mean age 47.7 years) underwent primary and revision operations, which were included in this study. The following clinical parameters were retrospectively assessed: the primary surgical methods, the intervals between primary and revision operations, and surgical findings in the revisions.


In total, 232 lumbar discs underwent reoperations. One hundred and nineteen reoperations were performed after microendoscopic discectomy (MED group), 68 after percutaneous endoscopic lumbar discectomy (PELD group) and 45 after open disc surgery (open group). The locations of revision operations had priority over those of primary surgery, with a moderate correlation (kappa coefficient = 0.533). A total of 46.6 % of reoperations were performed within 0.5 years after primary surgery, and 35.3 % were performed between one and five years. Real recurrent herniation (homolateral herniations at the same level) was significantly more common than other reoperative surgical findings (70.6 % in PELD group, 47.1 % in MED group, 37.8 % in open group). The overall mean interval until revision surgery was 18.9 months (8.1 months in the PELD group vs. 19.7 months in the MED group vs. 33.1 months in the open group, p < 0.01).


For LDH, real recurrent herniation was the most common cause of reoperations, and more reoperations for real recurrent herniations and shorter intervals were found after minimally invasive endoscopic discectomy than after open disc surgery.


Open Group Lumbar Disc Lumbar Disc Herniation Cerebrospinal Fluid Leakage Contralateral Herniation 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



This work was supported by the Key Project of Chinese Ministry of Health (no. 201002018) and the Foundation of the State Key Laboratory of Robotics (no. 2011-O01).

Conflict of interest

The authors declare that they have no conflict of interest.


  1. 1.
    Fandino J, Botana C, Viladrich A, Gomez-Bueno J (1993) Reoperation after lumbar disc surgery: results in 130 cases. Acta Neurochir (Wien) 122(1–2):102–104CrossRefGoogle Scholar
  2. 2.
    Suk KS, Lee HM, Moon SH, Kim NH (2001) Recurrent lumbar disc herniation: results of operative management. Spine (Phila Pa 1976) 26(6):672–676CrossRefGoogle Scholar
  3. 3.
    Atlas SJ, Keller RB, Chang Y, Deyo RA, Singer DE (2001) Surgical and nonsurgical management of sciatica secondary to a lumbar disc herniation: five-year outcomes from the Maine Lumbar Spine Study. Spine (Phila Pa 1976) 26(10):1179–1187CrossRefGoogle Scholar
  4. 4.
    Hakkinen A, Kiviranta I, Neva MH, Kautiainen H, Ylinen J (2007) Reoperations after first lumbar disc herniation surgery; a special interest on residives during a 5-year follow-up. BMC Musculoskelet Disord 9(8):2CrossRefGoogle Scholar
  5. 5.
    Matsumoto M, Watanabe K, Hosogane N, Tsuji T, Ishii K, Nakamura M, Chiba K, Toyama Y (2012) Recurrence of lumbar disc herniation after microendoscopic discectomy. J Neurol Surg A Cent Eur Neurosurg. doi: 10.1055/s-0032-1320031 Google Scholar
  6. 6.
    Kim CH, Chung CK, Park CS, Choi B, Kim MJ, Park BJ (2013) Reoperation rate after surgery for lumbar herniated intervertebral disc disease: nation-wide cohort study. Spine (Phila Pa 1976) 38(7):581–590CrossRefGoogle Scholar
  7. 7.
    Aizawa T, Ozawa H, Kusakabe T, Nakamura T, Sekiguchi A, Takahashi A, Sasaji T, Tokunaga S, Chiba T, Morozumi N, Koizumi Y, Itoi E (2012) Reoperation for recurrent lumbar disc herniation: a study over a 20-year period in a Japanese population. J Orthop Sci 17(2):107–113PubMedCrossRefGoogle Scholar
  8. 8.
    Lee JK, Amorosa L, Cho SK, Weidenbaum M, Kim Y (2010) Recurrent lumbar disk herniation. J Am Acad Orthop Surg 18(6):327–337PubMedGoogle Scholar
  9. 9.
    Chen Z, Zhao J, Liu A, Yuan J, Li Z (2009) Surgical treatment of recurrent lumbar disc herniation by transforaminal lumbar interbody fusion. Int Orthop 33(1):197–201PubMedCrossRefGoogle Scholar
  10. 10.
    Kayaoglu CR, Calikoglu C, Binler S (2003) Re-operation after lumbar disc surgery: results in 85 cases. J Int Med Res 31(4):318–323PubMedCrossRefGoogle Scholar
  11. 11.
    Erbayraktar S, Acar F, Tekinsoy B, Acar U, Guner EM (2002) Outcome analysis of reoperations after lumbar discectomies: a report of 22 patients. Kobe J Med Sci 48(1–2):33–41PubMedGoogle Scholar
  12. 12.
    Zhu H, Zhou XZ, Cheng MH, Shen YX, Dong QR (2011) The efficacy of coblation nucleoplasty for protrusion of lumbar intervertebral disc at a two-year follow-up. Int Orthop 35(11):1677–1682PubMedCrossRefGoogle Scholar
  13. 13.
    Kim JM, Lee SH, Ahn Y, Yoon DH, Lee CD, Lim ST (2007) Recurrence after successful percutaneous endoscopic lumbar discectomy. Minim Invasive Neurosurg 50(2):82–85PubMedCrossRefGoogle Scholar
  14. 14.
    Osterman H, Sund R, Seitsalo S, Keskimaki I (2003) Risk of multiple reoperations after lumbar discectomy: a population-based study. Spine (Phila Pa 1976) 28(6):621–627Google Scholar
  15. 15.
    Ruetten S, Komp M, Merk H, Godolias G (2008) Full-endoscopic interlaminar and transforaminal lumbar discectomy versus conventional microsurgical technique: a prospective, randomized, controlled study. Spine (Phila Pa 1976) 33(9):931–939CrossRefGoogle Scholar
  16. 16.
    McGirt MJ, Ambrossi GL, Datoo G, Sciubba DM, Witham TF, Wolinsky JP, Gokaslan ZL, Bydon A (2009) Recurrent disc herniation and long-term back pain after primary lumbar discectomy: review of outcomes reported for limited versus aggressive disc removal. Neurosurgery 64(2):338–344, 344–345PubMedCrossRefGoogle Scholar
  17. 17.
    Malter AD, McNeney B, Loeser JD, Deyo RA (1998) 5-year reoperation rates after different types of lumbar spine surgery. Spine (Phila Pa 1976) 23(7):814–820CrossRefGoogle Scholar
  18. 18.
    Keskimaki I, Seitsalo S, Osterman H, Rissanen P (2000) Reoperations after lumbar disc surgery: a population-based study of regional and interspecialty variations. Spine (Phila Pa 1976) 25(12):1500–1508CrossRefGoogle Scholar
  19. 19.
    Swartz KR, Trost GR (2003) Recurrent lumbar disc herniation. Neurosurg Focus 15(3):E10PubMedCrossRefGoogle Scholar
  20. 20.
    Cauchoix J, Ficat C, Girard B (1978) Repeat surgery after disc excision. Spine (Phila Pa 1976) 3(3):256–259CrossRefGoogle Scholar
  21. 21.
    Foley KT, Smith MM (1997) Microendoscopic discectomy. Tech Neurosurg 7(5):301–307Google Scholar
  22. 22.
    Yeung AT, Tsou PM (2002) Posterolateral endoscopic excision for lumbar disc herniation: surgical technique, outcome, and complications in 307 consecutive cases. Spine (Phila Pa 1976) 27(7):722–731CrossRefGoogle Scholar
  23. 23.
    Hoogland T, Schubert M, Miklitz B, Ramirez A (2006) Transforaminal posterolateral endoscopic discectomy with or without the combination of a low-dose chymopapain: a prospective randomized study in 280 consecutive cases. Spine (Phila Pa 1976) 31(24):E890–E897CrossRefGoogle Scholar
  24. 24.
    Spengler DM (1982) Lumbar discectomy. Results with limited disc excision and selective foraminotomy. Spine (Phila Pa 1976) 7(6):604–607CrossRefGoogle Scholar
  25. 25.
    Deyo RA, Weinstein JN (2001) Low back pain. N Engl J Med 344(5):363–370PubMedCrossRefGoogle Scholar
  26. 26.
    Ambrossi GL, McGirt MJ, Sciubba DM, Witham TF, Wolinsky JP, Gokaslan ZL, Long DM (2009) Recurrent lumbar disc herniation after single-level lumbar discectomy: incidence and health care cost analysis. Neurosurgery 65(3):574–578PubMedCrossRefGoogle Scholar
  27. 27.
    O’Sullivan MG, Connolly AE, Buckley TF (1990) Recurrent lumbar disc protrusion. Br J Neurosurg 4(4):319–325PubMedCrossRefGoogle Scholar
  28. 28.
    Cinotti G, Roysam GS, Eisenstein SM, Postacchini F (1998) Ipsilateral recurrent lumbar disc herniation. A prospective, controlled study. J Bone Joint Surg Br 80(5):825–832PubMedCrossRefGoogle Scholar
  29. 29.
    Wera GD, Marcus RE, Ghanayem AJ, Bohlman HH (2008) Failure within one year following subtotal lumbar discectomy. J Bone Joint Surg Am 90(1):10–15PubMedCrossRefGoogle Scholar
  30. 30.
    Dai LY, Zhou Q, Yao WF, Shen L (2005) Recurrent lumbar disc herniation after discectomy: outcome of repeat discectomy. Surg Neurol 64(3):226–231, 231PubMedCrossRefGoogle Scholar
  31. 31.
    Papadopoulos EC, Girardi FP, Sandhu HS, Sama AA, Parvataneni HK, O’Leary PF, Cammisa FJ (2006) Outcome of revision discectomies following recurrent lumbar disc herniation. Spine (Phila Pa 1976) 31(13):1473–1476CrossRefGoogle Scholar
  32. 32.
    Teli M, Lovi A, Brayda-Bruno M, Zagra A, Corriero A, Giudici F, Minoia L (2010) Higher risk of dural tears and recurrent herniation with lumbar micro-endoscopic discectomy. Eur Spine J 19(3):443–450PubMedCrossRefGoogle Scholar
  33. 33.
    Ahn Y (2012) Transforaminal percutaneous endoscopic lumbar discectomy: technical tips to prevent complications. Expert Rev Med Devices 9(4):361–366PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • Jiwei Cheng
    • 1
  • Hongwei Wang
    • 1
    Email author
  • Wenjie Zheng
    • 1
  • Changqing Li
    • 1
  • Jian Wang
    • 1
  • Zhengfeng Zhang
    • 1
  • Bo Huang
    • 1
  • Yue Zhou
    • 1
    Email author
  1. 1.Department of Orthopaedics, Xinqiao HospitalThe Third Military Medical UniversityChongqingPeople’s Republic of China

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