Efficacy of repeat discectomy alone versus with spinal fusion in recurrent lumbar disc herniation: a systematic review and meta-analysis of randomized studies

Abstract

Recurrent lumbar disc herniation (RLDH) is a common and debilitating condition. Surgical options include repeat Discectomy alone or with spinal Fusion, but the optimal approach remains debated. This meta-analysis evaluates their comparative efficacy. Following PRISMA guidelines, we conducted a systematic review and meta-analysis of randomized clinical trials (RCTs) comparing these procedures. Searches in PubMed, Embase, and Cochrane databases yielded four RCTs with 596 patients. Primary outcomes included the Visual Analog Scale (VAS), the Japanese Orthopaedic Association (JOA) scale, and re-recurrence rates. A random-effects model assessed pooled effects, and heterogeneity was measured with I² statistics. Fusion significantly reduced VAS scores for low back pain compared to Discectomy alone (SMD - 1.91; 95% CI [-3.69, -0.13]; p = 0.04; I²=98%). However, VAS scores for lower limb pain (MD -0.33; 95% CI [-0.70, 0.03]; p = 0.07; I²=95%) and JOA scores (MD 0.41; 95% CI [-0.38, 1.20]; p = 0.31; I²=0%) showed no significant differences between groups. The Fusion group had a lower re-recurrence rate (RR 0.10; 95% CI [0.02, 0.54]; p = 0.008; I²=0%) and reduced postoperative instability (RR 0.11; 95% CI [0.02, 0.63]; p = 0.01; I²=0%). Findings suggest that spinal Fusion enhances stability and reduces re-recurrence but does not significantly improve functional recovery or all pain aspects. Treatment choice should consider clinical factors, patient preferences, and surgeon expertise.

Keywords: Discectomy; Intervertebral disc displacement; Low back pain; Meta-analysis; Spinal diseases; Spinal fusion.