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

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.

Medical Data Analysis of Lumbar Disc Herniation Patients after Traditional Chinese Medicine Rehabilitation Intervention Lumbar Function Recovery

In order to study the efficacy of TCM rehabilitation for lumbar disc herniation, it is suggested to compare the effects of hot compress, ordinary sandbag, or hot compress with traditional Chinese medicine. A total of 79 patients with Qi stagnation and blood stasis syndrome in a traditional Chinese medicine hospital who met the diagnostic criteria of LDH and the syndrome classification in the diagnostic efficacy criteria of traditional Chinese medicine were selected. The subjects were randomly divided into groups A, B, and C: group A (26 cases) was the sandbag hot compress dry pregroup and received the simple sandbag hot compress scheme; group B (26 cases) was a simple traditional Chinese medicine hot compress intervention group, which received traditional Chinese medicine hot compress scheme; group C (27 cases) was the intervention group of traditional Chinese medicine sandbag combined with hot compress and received the scheme of traditional Chinese medicine sandbag combined with hot compress. In addition to the different hot compress media used, other aspects remained the same among the three groups. The treatment time of each hot compress was 40 min, twice a day for 2 weeks. A total of 14 cases fell out during the intervention process, and 65 subjects completed the intervention process. The experiment showed that there was no significant difference among the three groups (P > 0.05). The test results were confirmed.