Lumbar diskectomy for recurrent disk herniation.
Eighty-two patients who underwent reoperation using a lumbar microdiskectomy approach for recurrent back and leg pain were evaluated retrospectively. Patients were entered consecutively except for exclusion of those who had a spinal fusion in addition to the diskectomy or those where a diskectomy was performed as an adjunct to decompression for spinal stenosis. As a percentage of all diskectomies performed by us over the 13 years of the study, the overall rate of reoperation (including all patients who underwent more than one diskectomy procedure regardless of vertebral level and side) was 7.4%, with those having a reoperation on the same level and either the same or contralateral side as the initial procedure representing 4.5%. Long-term outcomes obtained from 68 questionnaire responses (83% compliance) included 56% who had successful leg pain relief, 54% who had successful back pain relief, 44% who successfully returned to work, 51% who successfully returned to normal activity, and 73% who were satisfied with the results of surgery. Poor outcomes correlated most significantly with reoperation on the same vertebral level, same side, and short (< or = 1 year) time interval between consecutive diskectomies. A major conclusion was that workers' compensation patients presenting within 1 year with recurrent complaints after diskectomy and whose radiologic findings indicate a same-level, same-side recurrence represent extremely poor outcome risks for repeat diskectomy.
Silvers
H R
HR
Southtowns Neurological Surgeons Associates, Buffalo, NY 14224.
Lewis
P J
PJ
Asch
H L
HL
Clabeaux
D E
DE
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017586:Diskectomy; D004651:Employment; D004824:Epidural Space / Q000473:pathology; D005260:Female; D005355:Fibrosis; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D007902:Length of Stay; D008159:Lumbar Vertebrae / Q000293:injuries / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011859:Radiography; D012008:Recurrence; D012086:Reoperation; D016896:Treatment Outcome; D014942:Workers' Compensation