title: Primary and revision lumbar discectomy. A 16-year review from one centre.
abstract: We present a review of 553 patients who underwent surgery for intractable sciatica ascribed to prolapsed lumbar intervertebral disc. One surgeon in one institution undertook or supervised all the operations over a period of 16 years. The total number of primary discectomies included in the study was 531, of which 42 subsequently required a second operation for recurrent sciatica, giving a revision rate of 7.9%. Factors associated with reoperation were analysed. A contained disc protrusion was almost three times more likely to need revision surgery, compared with extruded or sequestrated discs. Patients with primary protrusions had a significantly greater straight-leg raise and reduced incidence of positive neurological findings compared with those with extruded or sequestrated discs. These patients should therefore be selected out clinically and treated by a more enthusiastic conservative programme, since they are three times more likely to require revision surgery.
authors.affiliation: Department of Spinal Surgery, Robert Jones and Agnes Hunt Hospital, Oswestry, Shropshire, England.
authors.forename: C V J
authors.initials: CV
authors.lastname: Morgan-Hough
authors.forename: P W
authors.initials: PW
authors.lastname: Jones
authors.forename: S M
authors.initials: SM
authors.lastname: Eisenstein
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D017586:Diskectomy / Q000379:methods*; D005260:Female; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000150:complications / Q000601:surgery*; D008159:Lumbar Vertebrae; D008297:Male; D008875:Middle Aged; D009422:Nervous System Diseases / Q000209:etiology; D016017:Odds Ratio; D011183:Postoperative Complications / Q000209:etiology; D012008:Recurrence; D012086:Reoperation; D012307:Risk Factors; D012585:Sciatica / Q000209:etiology / Q000601:surgery*; D012737:Sex Factors; D013997:Time Factors