Long-term results of disc excision for recurrent lumbar disc herniation with or without posterolateral fusion

Study Design. A retrospective study assessing the long-term outcomes of repeat surgery for recurrent lumbar disc herniation. Objectives. To evaluate the results of repeat surgery for recurrent disc herniation, and compare the results of disc excision with and without posterolateral fusion. Summary of Background Data. The outcomes of revision surgery varied owing to the mixed patient populations. The optimal technique for treating recurrent disc herniation is controversial. Methods. The sample included 41 patients who underwent disc excision with or without posterolateral fusion, with an average follow-up of 88.7 months ( range, 60 - 134 months). Clinical symptoms were assessed based on the Japanese Orthopedic Association Back Scores. All medical and surgical records were examined and analyzed, including pain-free interval, intraoperative blood loss, length of surgery, and postsurgery hospital stay. Results. Clinical outcome was excellent or good in 80.5% of patients, including 78.3% of patients undergoing a discectomy alone, and 83.3% of patients with posterolateral fusion. The recovery rate was 82.2%, and the difference between the fusion and nonfusion groups was insignificant ( P = 0.799). The difference in the postoperative back pain score was also insignificant ( P = 0.461). These two groups were not different in terms of age, pain-free interval, and follow-up duration. Intraoperative blood loss, length of surgery, and length of hospitalization were significantly less in patients undergoing discectomy alone than in patients with fusion. Conclusions. Repeat surgery for recurrent sciatica is effective in cases of true recurrent disc herniation. Disc excision alone is recommended for managing recurrent disc herniation.