Clinical Characteristics of Recurrent Sciatica After Lumbar Discectomy

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Study DesignA prospective and consecutive study with preoperative collection of data using a standard protocol for data processing.ObjectivesThe frequency of common symptoms and signs was determined in patients with recurrent disc herniation (n = 22), symptomatic postoperative epidural and periradicular fibrosis after a previous lumbar disc excision (n = 18) and compared with the same variables in primary disc herniation (n = 150). The ultimate diagnostic criterion was the finding at surgery.Summary of Background DataSurgical treatment of recurrent sciatica after disc excision is rewarding in most cases of recurrent herniation but not in fibrosis and scarring.MethodsRecorded were pain at rest, at night, and upon coughing. Three categories of analgesic use were collected: 1) none, 2) intermittent, and 3) regular. Walking capacity was determined as more than 5 km, 1-5 km, 0.5-1.0 km, or less than 0.5 km. The straight leg raising test was graded as positive 0-30°, positive 30-60°, positive more than 60°, or negative. The results from a standardized neurologic examination were collected.ResultsPain at rest and pain at night were equally common in all three patient groups, although pain upon coughing was more common in disc herniation (primary and recurrent) than in fibrosis. Severe reduction of walking capacity was reported more commonly by patients with disc herniation, whereas regular consumption of analgesics was reported most frequently by patients with fibrosis.Positive straight leg raising tests were equally common in patients with primary and recurrent herniation and more common in these patients than in patients with fibrosis. The best symptoms and signs to distinguish between recurrent herniation and fibrosis were pain upon coughing, a severely reduced walking capacity, and straight leg raising test positive less than 30°; the presence of two or more of these parameters was found in 16 of 22 patients with recurrent herniation compared with five of 18 patients with fibrosis (P = 0.01).ConclusionThe symptoms and signs profiles show differences that may be of interest in differential diagnostic considerations after previous lumbar disc surgery.

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