We should turn our attention to why, and in whom, recurrent disc herniations occur. Are there certain risk factors for recurrence? The answer is likely yes, although we do not know for sure; I suspect that both technical and patient-related factors contribute. An incomplete list might include age, location, type and size of disc herniation, sex and size of patient, surgeon experience, surgical approach, and underlying medical conditions. By critically evaluating characteristics along those lines, we will better develop a better understanding of this risk.
Future studies should use registry information to help stratify and predict risk. The granularity needed to obtain this information will come from well-constructed clinical registries such as the North American Spine Society Registry, as opposed to administrative databases. Such studies will affect which patients are best served by surgery, what procedures we perform, and what kind of outcomes we can expect. The future is now.