title: Anterior discectomy and total disc replacement for three patients with multiple recurrent lumbar disc herniations.
abstract: BACKGROUND
  Although results of primary discectomy are generally excellent with relief of leg pain, recurrent lumbar disc herniation is relatively common ranging from 5% to 25%. Patients with recurrent herniation may undergo revision surgery; however, this carries with it increased risks and lower success rates. Many surgeons will advocate a fusion in addition to repeat discectomy after the third recurrent herniated disc. With the approval of lumbar total disc arthroplasty, there now exists another option for the patient with three or more recurrent disc herniations to preserve motion, theoretically decrease the rate of adjacent-level disease, and ameliorate the patient's symptoms.
  
  
  OBJECTIVE
  The purpose of this case report is to describe our experience using total disc replacement (TDR) in three patients after prior partial hemilaminectomy and discectomy for the treatment of a third and fourth recurrent lumbar disc herniation.
  
  
  METHODS
  This article is a report of three cases from a spine specialty center describing an alternative surgical technique for patients with multiple recurrent lumbar disc herniation.
  
  
  METHODS
  Comprehensive chart review of three patients with recurrent lumbar herniation who underwent TDR.
  
  
  RESULTS
  Anterior discectomy and TDR were undertaken, and at most recent follow-up (8-12 months), all patients had improvement of their visual analog scale and Oswestry Disability Index. No patient had postoperative complications or reoperation.
  
  
  CONCLUSIONS
  Recurrent disc herniation is a relatively common problem that may be difficult to treat. Traditionally, a patient presenting with three or more recurrent disc herniation may likely have undergone revision discectomy with fusion. The current case report suggests that TDR may be an alternative option in select patients.
authors: CORE Orthopaedic Medical Center, Encinitas, CA 92024, USA.
authors: Jamieson S
authors: JS
authors: Glenn
authors: Joseph
authors: J
authors: Yaker
authors: Richard D
authors: RD
authors: Guyer
authors: Donna D
authors: DD
authors: Ohnmeiss
mesh_terms: D000328:Adult; D017586:Diskectomy; D005260:Female; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000601:surgery*; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D020127:Recovery of Function; D012008:Recurrence; D012086:Reoperation; D059145:Total Disc Replacement; D016896:Treatment Outcome