Factors associated with lumbar disc hernia recurrence after microdiscectomy

Changes in Disc Height as a Prognostic Factor in Patients Undergoing Microscopic Discectomy

OBJECTIVE

Some patients with disc herniation who underwent discectomy complain of back pain after surgery and are unsatisfied with the surgical results. This study aimed to evaluate the relationship between preoperative disc height (DH), postoperative DH, and pain score 12 months after surgery in patients who underwent microdiscectomy for herniated lumbar disc.

METHODS

This study enrolled patients who underwent microdiscectomy at a medical center between January 2012 and December 2020. Patients with X-ray or computed tomography and pain score assessment (visual analog scale score) prior to surgery, immediately post-op, and at 1, 6, and 12 months after surgery were included. The DH index was defined as DH/overlying vertebral width. The DH ratio was defined as the postoperative DH/preoperative DH. Simple linear regression and multivariate linear regression analyses were applied to assess the correlation between DHs and leg pain scores 12 months after surgery.

RESULTS

A total of 118 patients who underwent microdiscectomy were included. DH decreased up to 12 months after surgery. The DH ratio at 1, 6, and 12 months after discectomy showed a significant positive correlation with the pain scores at 12 months after discectomy (1 month : p=0.045, B=0.52; 6 months : p=0.008, B=0.78; 12 months : p=0.005, B=0.69). Multivariate linear regression analysis revealed that the level of surgery, sex, age, and body mass index had no significant relationship with back pain scores after 12 months.

CONCLUSION

In patients who underwent microdiscectomy, the DH ratios at 1, 6, and 12 months after surgery were prognostic factors for back pain scores at 12 months after surgery. Aggressive discectomy is recommended for lower postoperative DH ratios and Visual analog scale scores, leading to improved patient satisfaction.

Moderate to Severe Multifidus Fatty Atrophy is the Risk Factor for Recurrence After Microdiscectomy of Lumbar Disc Herniation

OBJECTIVE

We attempted to investigate the potential risk factors of recurrent lumbar disc herniation (rLDH) after tubular microdiscectomy.

METHODS

We retrospectively analyzed the data of patients who underwent tubular microdiscectomy. The clinical and radiological factors were compared between the patients with and without rLDH.

RESULTS

This study included 350 patients with lumbar disc herniation (LDH) who underwent tubular microdiscectomy. The overall recurrence rate was 5.7% (20 of 350). The visual analogue scale (VAS) score and Oswestry Disability Index (ODI) at the final follow-up significantly improved compared with those preoperatively. There was no significant difference in the preoperative VAS score and ODI between the rLDH and non-rLDH groups, while the leg pain VAS score and ODI of the rLDH group were significantly higher than those of the non-rLDH group at final follow-up. This suggested that rLDH patients had a worse prognosis than non-rLDH patients even after reoperation. There were no significant differences in sex, age, body mass index, diabetes, current smoking and drinking, disc height index, sagittal range of motion, facet orientation, facet tropism, Pfirrmann grade, Modic changes, interdisc kyphosis, and large LDH between the 2 groups. Univariate logistic regression analysis revealed that rLDH was associated with hypertension, multilevel microdiscectomy, and moderate-severe multifidus fatty atrophy (MFA). A multivariate logistic regression analysis indicated that MFA was the sole and strongest risk factor for rLDH after tubular microdiscectomy.

CONCLUSION

Moderate-severe MFA was a risk factor for rLDH after tubular microdiscectomy, which can serve as an important reference for surgeons in formulating surgical strategies and the assessment of prognosis.

Reoperations after primary and revision lumbar discectomy: study of a national-level cohort with eight years follow-up

BACKGROUND CONTEXT

Published rates for disc reherniation following primary discectomy are around 6%, but the ultimate reoperation outcomes in patients after receiving revision discectomy are not well understood. Additionally, any disparity in the outcomes of subsequent revision discectomy (SRD) versus subsequent lumbar fusion (SLF) following primary/revision discectomy remains poorly studied.

PURPOSE

To determine the 8-year SRD/SLF rates and time until SRD/SLF after primary/revision discectomy respectively.

STUDY DESIGN

Retrospective cohort study.

PATIENT SAMPLE

Patients undergoing primary or revision discectomy, with records in the PearlDiver Patient Records Database from the years 2010 to 2019.

OUTCOME MEASURES

Subsequent surgery type and time to subsequent surgery.

METHODS

Patients were grouped into primary or revision discectomy cohorts based off of the nature of "index" procedure (primary or revision discectomy) using ICD9/10 and CPT procedure codes from 2010 to 19 insurance data sets in the PearlDiver Patient Records Database. Preoperative demographic data was collected. Outcome measures such as subsequent surgery type (fusion or discectomy) and time to subsequent surgery were collected prospectively in PearlDiver Mariner database. Statistical analysis was performed using BellWeather statistical software. A Kaplan-Meier survival analysis of time to SLF/SRD was performed on each cohort, and log-rank test was used to compare the rates of SLF/SRD between cohorts.

RESULTS

A total of 20,147 patients were identified (17,849 primary discectomy, 2,298 revision discectomy). The 8-year rates of SRD (6.1% in revision cohort, 4.8% in primary cohort, p<.01) and SLF (10.4% in revision cohort, 6.2% in primary cohort, p<.01) were higher after revision versus primary discectomy. Time to SLF was shorter after revision versus primary discectomy (709 vs. 886 days, p<.01). After both primary and revision discectomy, the 8-year rate of SLF (10.4% in revision cohort, 6.2% in primary cohort, p<.01) is greater than SRD (6.1% in revision cohort, 4.8% in primary cohort, p<.01).

CONCLUSIONS

Compared to primary discectomy, revision discectomy has higher rates of SLF (10.4% vs. 6.2%), and faster time to SLF (2.4 vs. 1.9 years) at 8-year follow up.

Low-Dose Collagenase Chemonucleolysis Combined with Radiofrequency in the Treatment of Lumbar Disc Herniation: A 10-Year Retrospective Study

Objective

This study explored the 10-year efficacy, safety, and prognostic factors of low-dose collagenase chemonucleolysis (CCNL) combined with radiofrequency (RF) in the treatment of lumbar disc herniation (LDH).

Methods

The data of 167 LDH patients were collected. Modified MacNab criteria, Numerical Rating Scale (NRS), and Japanese Orthopedic Association (JOA) scores were, respectively, used to evaluate patients' excellent and good rates, pain degree, and nerve function. The preoperative and 10-year postoperative patients' pain, numbness, and muscle weakness were compared. Patients' complications in perioperative period, recurrent/reappeared LDH, and reoperations were recorded. Finally, the independent risk factors affecting the long-time efficacy were assessed.

Results

A total of 126 patients were included. The patients' excellent and good rates were 86.51%–92.86% with no significant difference (P > 0.05). Postoperative NRS and JOA scores significantly improved (P < 0.01), most obvious within 6 months postoperatively. At 10 years postoperatively, 65.08%, 83.95%, and 93.02% of patients' pain, numbness, and muscle weakness were completely relieved (P < 0.05). Perioperative complications occurred in three patients with the rate of 2.38%. Recurrent/reappeared LDH patients were 11 with the ratio of 8.73%; nine of them underwent reoperations with the rate of 7.14%. And patients' probability of fair and poor efficacy at 10 years postoperatively with the course of disease >12 months and the responsibility disc ≥2 were, respectively, 6.005 and 4.227 times that of patients with the course of disease ≤12 months and the responsibility disc = 1 (P < 0.05).

Conclusion

The combined treatment is effective and safe in the long term. A course of disease >12 months and responsibility disc ≥2 independently reduce efficacy, and a course of disease >12 months has a more significant impact.