title: Recurrent disc herniation and long-term back pain after primary lumbar discectomy: review of outcomes reported for limited versus aggressive disc removal.
abstract: OBJECTIVE
  It remains unknown whether aggressive disc removal with curettage or limited removal of disc fragment alone with little disc invasion provides a better outcome for the treatment of lumbar disc herniation with radiculopathy. We reviewed the literature to determine whether outcomes reported after limited discectomy (LD) differed from those reported after aggressive discectomy (AD) with regard to long-term back pain or recurrent disc herniation.
  
  
  METHODS
  A systematic MEDLINE search was performed to identify all studies published between 1980 and 2007 reporting outcomes after AD or LD for a herniated lumbar disc with radiculopathy. The incidence of short- and long-term recurrent back or leg pain and recurrent disc herniation was assessed from each reported LD or AD cohort and the cumulative incidence compared.
  
  
  RESULTS
  Fifty-four studies (60 discectomy cohorts) met the inclusion criteria, reporting the outcomes of 13 359 patients after lumbar discectomy (LD, 6135 patients; AD, 7224 patients). The reported incidence of short-term recurrent back or leg pain was similar after LD (mean, 14.5%; range, 7-16%) and AD (mean, 14.1%; range, 6-43%) (P < 0.01). However, more than 2 years after surgery, the reported incidence of recurrent back or leg pain was 2.5-fold less after LD (mean, 11.6%; range, 7-16%) compared with AD (mean, 27.8%; range, 19-37%) (P < 0.0001). The reported incidence of recurrent disc herniation after LD (mean, 7%; range, 2-18%) was greater than that reported after AD (mean, 3.5%; range, 0-9.5%) (P < 0.0001).
  
  
  CONCLUSIONS
  Review of the literature demonstrates a greater reported incidence of long-term recurrent back and leg pain after AD but a greater reported incidence of recurrent disc herniation after LD. Prospective, randomized trials are needed to firmly assess this possible difference.
authors.affiliation: Department of Neurosurgery, The Johns Hopkins Spinal Column Biomechanics and Surgical Outcomes Laboratory, The Johns Hopkins Hospital, Baltimore, Maryland 21287, USA.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: McGirt
authors.forename: Giannina L Garcés
authors.initials: GL
authors.lastname: Ambrossi
authors.forename: Ghazala
authors.initials: G
authors.lastname: Datoo
authors.forename: Daniel M
authors.initials: DM
authors.lastname: Sciubba
authors.forename: Timothy F
authors.initials: TF
authors.lastname: Witham
authors.forename: Jean-Paul
authors.initials: JP
authors.lastname: Wolinsky
authors.forename: Ziya L
authors.initials: ZL
authors.lastname: Gokaslan
authors.forename: Ali
authors.initials: A
authors.lastname: Bydon
mesh_terms: D001416:Back Pain / Q000209:etiology* / Q000517:prevention & control*; D015897:Comorbidity; D017586:Diskectomy / Q000379:methods* / Q000706:statistics & numerical data*; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control / Q000601:surgery*; D008159:Lumbar Vertebrae / Q000601:surgery*; D015995:Prevalence; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D055502:Secondary Prevention; D016896:Treatment Outcome