Management of recurrent lumbar disc herniation: a comparative analysis of posterior lumbar interbody fusion and repeat discectomy

Gerald Musa; Serik K Makirov; Gennady E Chmutin; Sergey V Susin; Alexander V Kim; Gennady I Antonov; Olzhas Otarov; Dimitri T K Ndandja; Chmutin Egor G; Bipin Chaurasia

doi:10.1097/MS9.0000000000001600

Management of recurrent lumbar disc herniation: a comparative analysis of posterior lumbar interbody fusion and repeat discectomy

Ann Med Surg (Lond). 2024 Jan 3;86(2):842-849. doi: 10.1097/MS9.0000000000001600. eCollection 2024 Feb.

Authors

Affiliations

¹ Department of Neurological Diseases and Neurosurgery, Peoples' Friendship University of Russia (RUDN University).
² Department of Vertebrology, Scientific and Technical Center, Family Clinic.
³ Department of Neurosurgery, City Clinical Hospital 68 named after Demihov.
⁴ Department of Neurosurgery, Central Military Clinical Hospital named after A.A Vishnevsky of the Ministry of Defense of the Russian Federation.
⁵ Department of Neurological diseases and Neurosurgery, Peoples friendship University of Russia (RUDN University), Moscow, Russia.
⁶ Department of Neurosurgery, Neurosurgery Clinic, Birgunj , Nepal.

Abstract

Background: For recurrent lumbar disc herniation, many experts suggest a repeat discectomy without stabilization due to its minimal tissue manipulation, lower blood loss, shorter hospital stay, and lower cost, recent research on the role of instability in disc herniation has made fusion techniques popular among spinal surgeons. The authors compare the postoperative outcomes of posterior lumbar interbody fusion (PLIF) and repeat discectomy for same-level recurrent disc herniation.

Methods: The patients included had previously undergone discectomy and presented with a same-level recurrent lumbar disc herniation. The patients were placed into two groups: 1) discectomy only, 2) PLIF based on the absence or presence of segmental instability. Preoperative and postoperative Oswestry disability index scores, duration of surgery, blood loss, duration of hospitalization, and complications were analyzed.

Results: The repeat discectomy and fusion groups had 40 and 34 patients, respectively. The patients were followed up for 2.68 (1-4) years. There was no difference in the duration of hospitalization (3.73 vs. 3.29 days P=0.581) and operative time (101.25 vs. 108.82 mins, P=0.48). Repeat discectomy had lower intraoperative blood loss, 88.75 ml (50-150) versus 111.47 ml (30-250) in PLIF (P=0.289). PLIF had better ODI pain score 4.21 (0-10) versus 9.27 (0-20) (P-value of 0.018). Recurrence was 22.5% in repeat discectomy versus 0 in PLIF.

Conclusion: PLIF and repeat discectomy for recurrent lumbar disc herniation have comparable intraoperative blood loss, duration of surgery, and hospital stay. PLIF is associated with lower durotomy rates and better long-term pain control than discectomy. This is due to recurrence and progression of degenerative process in discectomy patients, which are eliminated and slowed, respectively, by PLIF.

Keywords: discectomy; fusion; oswestry disability index; posterior lumbar interbody fusion; recurrent lumbar disc herniation.