Should Patients With Recurrent Lumbar Disc Herniations be Fused?

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Excerpt

Michael Elsenbeck, MD
Lumbar discectomy is the most commonly performed surgical procedure for radiculopathy caused by a LDH.1,2 Historically, open discectomy or microdiscectomy have provided good results and remain the “gold standard” for symptomatic LDH. More recently, minimally invasive discectomy procedures designed to limit soft tissue damage have evolved. Despite theoretical advantages of less blood loss, lower infection rates, and less postoperative pain, minimally invasive discectomy techniques have failed to demonstrate a significant advantage in patient reported outcomes.3–5 Irrespective of the technique utilized, rates of recurrent disc herniation range from 5% to 18%, representing the most common cause of surgical failure and subsequent reoperation.3,6 A recent survey conducted by Mroz et al7 demonstrated the heterogeneity of treatment recommendations for recurrent disc herniation among 445 spine surgeons. Overall, there was a 22% and 69% probability of disagreement on the surgical treatment of 1- and 2-time recurrent disc herniations, respectively.7 Revision surgical treatment options include, revision microdiscectomy alone versus microdiscectomy with posterior fusion±lumbar interbody fusion. Despite, the paucity of literature comparing revision surgical options for recurrent LDH, revision microdiscectomy remains a viable option with predictable outcomes.

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