title: Microsurgery for recurrent lumbar disk herniation at the same level and side: do patients fare worse? Experience with 95 consecutive cases.
abstract: BACKGROUND
  In reviewing our experience with reoperation of RLDH, our aim was mainly to determine whether patients fared worse than after primary surgery. We found no uniform answers to this question in the literature.
  
  
  METHODS
  The data of 95 patients (29 women and 66 men) who underwent reoperation for RLDH at the same level and side were analyzed retrospectively. Forty-two patients underwent the first operation in our clinic (recurrence rate, 2.6% of 1586 cases). Gadolinium-enhanced MRI was performed in all patients. Main clinical data of patients, pain-free interval, operation time, surgical complications, duration of hospital stay, and clinical improvement rate were recorded.
  
  
  RESULTS
  The mean pain-free interval was 55 months (range, 3-120 months). Levels of recurrent herniation were L4 through L5 and L5 through S1 (65% and 35% of cases, respectively). Revision surgery lasted longer on average than the previous diskectomy (P < .01) and was complicated by dural tear in 4 cases (4.2% vs 0.9% during primary diskectomy, P < .05). There were no significant differences between revision and previous surgery in terms of hospital stay. However, rates of excellent/good outcomes were significantly less for RLDH (89% vs 95%, P < .05); and the percentage of poor results was higher (2% vs 0.5%, P < .05). Age, sex, smoking, profession, trauma, level and degree of herniation, and pain-free interval were not correlated with clinical outcome.
  
  
  CONCLUSIONS
  Conventional microsurgery for RLDH showed lightly but significantly worse results than those of primary microdiskectomy. Patients contemplating reoperation should be informed of this fact and of the risk of dural tear and prolonged operation time.
authors.affiliation: Department of Ophthalmological and Neurosurgical Sciences, Neurosurgical Clinic, Siena University Medical School, 53100 Siena, Italy. palma@unisi.it
authors.forename: Lucio
authors.initials: L
authors.lastname: Palma
authors.forename: Biagio
authors.initials: B
authors.lastname: Carangelo
authors.forename: Vitaliano F
authors.initials: VF
authors.lastname: Muzii
authors.forename: Aldo
authors.initials: A
authors.lastname: Mariottini
authors.forename: Alessandro
authors.initials: A
authors.lastname: Zalaffi
authors.forename: Serena
authors.initials: S
authors.lastname: Capitani
mesh_terms: D015331:Cohort Studies; D018572:Disease-Free Survival; D017586:Diskectomy; D005260:Female; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000473:pathology / Q000601:surgery*; D017116:Low Back Pain / Q000209:etiology / Q000517:prevention & control; D008159:Lumbar Vertebrae; D008297:Male; D008866:Microsurgery; D012008:Recurrence; D012086:Reoperation; D012189:Retrospective Studies; D016896:Treatment Outcome