J Korean Soc Spine Surg.  2007 Sep;14(3):151-157. 10.4184/jkss.2007.14.3.151.

Treatment Outcome of Reoperative Lumbar Disc Herniation

• Lee KY
• Shon SK
• Lee MJ
• Wang L

• KMID: 1941646
• DOI: http://doi.org/10.4184/jkss.2007.14.3.151

Abstract

STUDY DESIGN: A retrospective study.
OBJECTIVES
To analyze the causes and treatment outcomes of reoperation after a lumbar discectomy. SUMMARY OF LITERATURE REVIEW: The major causes of reoperation after a lumbar disc surgery is recurrent disc herniation. Satisfactory outcomes can be obtained with reoperation for patients still requiring treatment.
MATERIALS AND METHODS
Fifty two patients, who had undergone reoperations after lumbar discectomies with a minimum followup period of one year, were reviewed. The causes of the reoperation were analyzed according to the physical examination and conventional radiographic evaluation. The surgical outcome was assessed using the JOA score and Kirkaldy-Willis criteria, and the recovery rate was calculated according to the JOA score. Statistical analysis was carried out to evaluate the factors that might influence the outcome of reoperation.
RESULTS
The causes of reoperation after lumbar disc surgery included 46 cases of recurrent disc herniation, each two cases of the wrong level, spinal canal stenosis and lumbar instability. The average JOA score increased from 11 to 24, and the average recovery rate was approximately 72%. According to the Kirkaldy-Willis criteria, the results were excellent and good in approximately 85% of cases. Statistical analysis revealed that the factors associated with a successful outcome were a single previous surgical procedure (p.0.02), a preoperative JOA score over 10 points (p.0.01), and a pain-free interval of more than 12 months after the previous operation(p.0.01).
CONCLUSION
The treatment outcomes of reoperative lumbar disc herniation were satisfactory. Factors, such as the low number of prior procedures, high preoperative JOA score, and long pain-free interval after a previous operation, can lead to a successful treatment outcome of reoperation.

Keyword

Reoperation; Lumbar disc herniation; Treatment outcome

MeSH Terms

Constriction, Pathologic
Diskectomy
Follow-Up Studies
Humans
Physical Examination
Reoperation
Retrospective Studies
Spinal Canal
Treatment Outcome*

Figure

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  Fig. 1. 54 year-old male patients. (A) Preoperative Magnetic Resonance image shows L4-5 lateral recess type of stenosis in previous discectomy level. (B) Posterior decompression and posterolateral fusion was done. JOA score increased to 7 to 19, with the recovery rate of 54.5%. Finally, clinical result was fail according to the Kirkaldy-Willis criteria.

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  Fig. 2. 43 year-old male patient. (A) Preoperative radiographs shows isthmic defect with instability in previous discectomy level at L4-5. (B) Posterior decompression and posterolateral fusion was done. JOA score increased to 10 to 25, with the recovery rate of 78.9%. End result was good according to the Kirkaldy-Willis criteria.

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  Fig. 3. 28 year-old female patient. (A) T2-weight axial MR image shows right-sided extrusion of the L4-5 disc. (B) MR image shows left-sided disc extrusion of the recurrent disc at the same level. Open laminectomy and discectomy was done. JOA score increased to 13 to 25, with the recovery rate of 75%. End result was good according to the Kirkaldy-Willis criteria.

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