Treatment for Recurrent Lumbar Disc Herniation
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Purpose of Review
Recurrent lumbar disc herniation (RLDH) is the most common indication for reoperation after a lumbar discectomy. The purpose of this manuscript is to review the incidence, risk factors, and treatment for RLDH.
Patients who require revision surgery for RLDH improved significantly compared to baseline; however, the magnitude of improvement is less than in primary discectomy patients. Treatment with either repeat discectomy or instrumented fusion has comparable clinical outcomes. Repeat discectomy patients, however, have shorter operative times and length of stay. Hospital charges are dramatically lower for repeat discectomy compared to instrumented fusion.
The incidence of RLDH is somewhere between 5 and 18%. Risk factors include younger age, lack of a sensory or motor deficit, and a higher baseline Oswestry Disability Index (ODI) score. Available evidence suggests that some patients may respond to nonoperative interventions and avoid the need for reoperation. For those that fail a trial of conservative management or present with neurologic deficit, both repeat lumbar discectomy and instrumented fusion appear to effectively treat patients with similar complication rates and clinical outcomes.
KeywordsRecurrent lumbar disc herniation Lumbar spondylosis Lumbar radiculopathy Lumbar discectomy Lumbar fusion
Compliance with ethical standards
Conflict of Interest
Randall J. Hlubek declares that he has no conflict of interest.
Gregory M. Mundis Jr. reports personal fees from Nuvasive, K2M and Allosource, a patent Nuvasive with royalties paid, and a patent K2M with royalties paid.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
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