Clinical characteristics of recurrent sciatica after lumbar discectomy.
METHODS
A prospective and consecutive study with preoperative collection of data using a standard protocol for data processing.


OBJECTIVE
The frequency of common symptoms and signs was determined in patients with recurrent disc herniation (n = 22), symptomatic postoperative epidural and periradicular fibrosis after a previous lumbar disc excision (n = 18) and compared with the same variables in primary disc herniation (n = 150). The ultimate diagnostic criterion was the finding at surgery.


BACKGROUND
Surgical treatment of recurrent sciatica after disc excision is rewarding in most cases of recurrent herniation but not in fibrosis and scarring.


METHODS
Recorded were pain at rest, at night, and upon coughing. Three categories of analgesic use were collected: 1) none, 2) intermittent, and 3) regular. Walking capacity was determined as more than 5 km, 1-5 km, 0.5-1.0 km, or less than 0.5 km. the straight leg raising test was graded as positive 0 - 1.0 km, or less than 0.5 km. The straight leg raising test was graded as positive 0-30 degrees, positive 30-60 degrees, positive more than 60 degrees, or negative. The results from a standardized neurologic examination were collected.


RESULTS
Pain at rest and pain at night were equally common in all three patient groups, although pain upon coughing was more common in disc herniation (primary and recurrent) than in fibrosis, Severe reduction of walking capacity was reported more commonly by patients with dis herniation, whereas regular consumption of analgesics was reported most frequently by patients with fibrosis.


CONCLUSIONS
The symptoms and signs profiles show differences that may be of interest in differential diagnostic considerations after previous lumbar disc surgery.
Jönsson
B
B
Department of Orthopedics, Lund University Hospitial, Sweden.
Strömqvist
B
B
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017586:Diskectomy; D005260:Female; D005355:Fibrosis; D005500:Follow-Up Studies; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000150:complications / Q000473:pathology / Q000601:surgery*; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011446:Prospective Studies; D012008:Recurrence; D012585:Sciatica / Q000209:etiology*