title: Recurrent lumbar disc herniation after single-level lumbar discectomy: incidence and health care cost analysis.
abstract: OBJECTIVE
  Same-level recurrent lumbar disc herniation complicates outcomes after primary discectomy in a subset of patients. The health care costs associated with the management of this complication are currently unknown. We set out to identify the incidence and health care cost of same-level recurrent disc herniation after single-level lumbar discectomy at our institution.
  
  
  METHODS
  We retrospectively reviewed 156 consecutive patients undergoing primary single-level lumbar discectomy at one institution. The incidence of symptomatic same-level recurrent disc herniation either responding to conservative therapy or requiring revision discectomy was assessed. Institutional billing and accounting records were reviewed to determine the billing costs of all diagnostic and therapeutic measures used for patients experiencing recurrent disc herniation.
  
  
  RESULTS
  Twelve months after surgery, 141 patients were available for follow-up. Of these patients, 124 (88%) were symptom free or had minimal symptoms not affecting their daily activity. Radiographically proven symptomatic same-level recurrent disc herniation developed in 17 patients (12%) a median of 8 months after primary discectomy. Eleven patients (7%) required revision surgery, whereas 6 (3.9%) responded to conservative therapy alone. Diagnosis and management of recurrent disc herniation were associated with a mean cost of $26,593 per patient, and the mean cost was markedly less for patients responding to conservative treatment ($2315) compared with those requiring revision surgery ($39,836) (P < 0.001). Of 141 primary lumbar discectomies performed at our institution with the patients followed for 1 year, the total cost associated with the management of subsequent recurrent disc herniation was $452,083 ($289,797 per 100 primary discectomies).
  
  
  CONCLUSIONS
  In our experience, recurrent lumbar disc herniation occurred in more than 10% of patients and was associated with substantial health care costs. Development of novel techniques to prevent recurrent lumbar disc herniation is warranted to decrease the health care costs and morbidity associated with this complication. Prolonged conservative management should be attempted when possible to reduce the health care costs of this complication.
authors.affiliation: Department of Neurosurgery, The Johns Hopkins Hospital, Baltimore, Maryland 21287, USA.
authors.forename: Giannina L Garcés
authors.initials: GL
authors.lastname: Ambrossi
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: McGirt
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: Donlin M
authors.initials: DM
authors.lastname: Long
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017586:Diskectomy / Q000191:economics* / Q000379:methods*; D005260:Female; D017048:Health Care Costs; D006801:Humans; D015994:Incidence; D007405:Intervertebral Disc Displacement / Q000191:economics* / Q000601:surgery*; D008159:Lumbar Vertebrae / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D055502:Secondary Prevention; D016896:Treatment Outcome; D055815:Young Adult