title: Revision Surgery for "Real" Recurrent Lumbar Disk Herniation: A Systematic Review.
abstract: METHODS
  A systematic review.
  
  
  OBJECTIVE
  To systematically review the previous literature regarding revision surgery for real recurrent lumbar disk herniation.
  
  
  BACKGROUND
  "Real" recurrent lumbar disk herniation means the presence of herniated disk material at the same level and side as the primary disk herniation. If conservative treatment fails, revision surgery, a major concern, is indicated. It is important for both patients and spine surgeons to understand epidemiology trends and outcomes of revision surgery for real recurrent lumbar disk herniation (real-RLDH).
  
  
  METHODS
  The electronic databases PubMed, the Cochrane library, and EMBASE were queried for English articles regarding revision surgery for real-RLDH, published between January 1980 and May 2014. The incidence, interval between primary and revision surgery, risk factors, surgery type, complications, and clinical outcomes of revision surgery for real-RLDH were summarized.
  
  
  RESULTS
  The reported incidence of revision surgery, specifically for real-RLDH, lies between 1.4% and 11.4%. The complication rate is reported between 0% and 34.6%, with dural tear being the most common complication. Previous studies revealed that satisfactory or successful clinical outcome was achieved in 60%-100% of patients after revision surgery for real-RLDH. Several studies reported similar clinical outcomes between primary and revision surgery.
  
  
  CONCLUSIONS
  The incidence of revision surgery for real-RLDH is relatively low. It is essential to pay careful attention to prevent a dural tear. Patients may expect clinical outcomes similar to those following primary discectomy.
authors.affiliation: *Department of Orthopaedics, SUNY Downstate Medical Center, Brooklyn †Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Nagoya City University, Nagoya Aichi, Japan ‡Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, NY.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Yoshihara
authors.forename: Dipal
authors.initials: D
authors.lastname: Chatterjee
authors.forename: Carl B
authors.initials: CB
authors.lastname: Paulino
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Errico
mesh_terms: D006801:Humans; D007405:Intervertebral Disc Displacement / Q000601:surgery*; D008159:Lumbar Vertebrae / Q000601:surgery*; D011183:Postoperative Complications / Q000209:etiology; D012008:Recurrence; D012086:Reoperation / Q000009:adverse effects; D012307:Risk Factors; D016896:Treatment Outcome