Clinical Outcome of Simple Discectomy for Recurrent Lumbar Disc Herniation

Dong Jun Kim; Young Do Koh; Jong Oh Kim; Hyung Mook Lim

doi:10.4184/jkss.2015.22.4.140

Journal List > J Korean Soc Spine Surg > v.22(4) > 1076061

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Kim, Koh, Kim, and Lim: Clinical Outcome of Simple Discectomy for Recurrent Lumbar Disc Herniation

Original Article

Journal of Korean Spine Surg 2015;22(4):140-145.

Published online: 21 December 2015

DOI: https://doi.org/10.4184/jkss.2015.22.4.140

Clinical Outcome of Simple Discectomy for Recurrent Lumbar Disc Herniation

Dong Jun Kim, M.D., Young Do Koh, M.D., Jong Oh Kim, M.D., Hyung Mook Lim, M.D.

Department of Orthopedic Surgery, Ewha Womans University College of Medicine, Seoul, Korea

Corresponding author: Young Do Koh, M.D. 911-1, mok 6-dong, Yangcheon-gu, Seoul, Korea, Department of orthopedic surgery, Ewha womans university college of medicine TEL: +82-2-2650-5564, FAX: +82-2-2642-0349 E-mail: ydkoh@ewha.ac.kr

Received 23 March 201518 May 2015 Accepted 7 September 2015

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Study Design

This is a retrospective study.

Objectives

To analyze the clinical outcomes of simple discectomy in patients with recurrent lumbar disc herniation.

Summary of Literature Review

There are two methods of studying the treatment of recurrent lumbar disc herniation. The first type of study considers fusion for the prevention of complications such as postoperative lumbar segmental instability and persistent back pain. The second type of study assumes that simple discectomy without fusion is sufficient in the surgical management of recurrent lumbar disc herniation.

Materials and Methods

Sixteen patients who underwent simple discectomy due to recurrent lumbar disc herniation were followed up over 3 years. The mean age was 52.8 years (38-68 years). The mean followup period was 75.4 months (36-144 months). VAS scores for back pain and radiating lower leg pain were each compared pre- and postoperatively. The Oswestry Disability Index (ODI) was used to analyze the clinical outcome. A modified MacNab's outcome was used to evaluate patient satisfaction. Subjective survey data in a Delphi checklist was reviewed to verify clinical lumbar instability.

Results

The mean back pain VAS score showed 87.5% improvement (p<0.001). The mean lower leg VAS score showed 89% improvement (p<0.001). The mean preoperative ODI score was 29.9, and the mean score checked at the last follow up was 3.5. It thus showed 88.3% improvement (p<0.001). Excellent or good satisfaction was reported by fourteen patients (87.5%), and clinical lumbar instability was identified in one patient (6.3%).

Conclusions

Simple discectomy without fusion is one of treatment option for recurrent disc herniation without instability.

Keywords: Lumbar, Recurrence, Disc herniation, Discectomy

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Figures and Tables%

Fig. 1.

(A) Left L4-5 disc herniation, (B) After laminectomy and discectomy, (C) Recurrence at 14 months postoperatively.

Table 1.

Delphi Check List for Diagnosing Lumbar Segmental Instability (Subjective Descriptors)

Questions
Reported feeling of “giving way”
Frequently felt need to crack or pop the back
Frequently felt need to crack or pop the back Frequent bouts or pain episodes
Frequent bouts or pain episodes History of painful catching or locking during bending or twisting
Pain during transitions
Greater pain during returning from flexion
Increase in pain with sudden or mild movements
Discomfort with unsupported sitting
Worsening with sustained postures
Progressive worsening of condition
Long chronic history
Temporary relief with back supports
Frequent episodes of muscle spasms

Table 2.

Patient Profiles of Recurrent Lumbar Disc Herniation

Sex	Age (years)	Level	Interval between revision and recurrence (month)	Follow up duration (month)
Male	57	L4-5	84	36
Male	68	L4-5	36	109
Male	41	L4-5	72	126
Male	38	L5-S1	60	103
Female	50	L4-5	31	93
Female	62	L4-5	14	65
Male	48	L5-S1	36	60
Female	47	L4-5	24	44
Male	36	L4-5	27	39
Male	42	L4-5	42	39
Female	57	L4-5	6	144
Male	46	L4-5	120	36
Female	66	L4-5	84	82
Male	65	L5-S1	41	81
Male	59	L4-5	7	80
Male	64	L4-5	6	70
	52.8		43.1	75.4

Table 3.

Clinical Outcome of Repeat Discectomy

	Mean value	Recovery rate	p-value
Pre-op back VAS*	8(5-10)	87.5%	<0.001
Last F/U ^† back VAS	1(0-3)
Pre-op lower leg VAS	7.3(2-10)	89%	<0.001
Last F/U lower leg VAS	0.8(0-2)
Pre-op ODI ^‡	29.9(18-48)	88.3%	<0.001
Last F/U ODI	3.5(0-13)

^∗ VAS: Visual analogue scale

^† F/U: Duration follow up

^‡ ODI: Oswestry disability index.

Table 4.

Modified MacNab's Outcome Assessment of Patient Satisfaction

	Outcome description of criteria	Number of patient
Excellent	No pain; no restriction of mobility; return to normal work & level of activity	8(50%)
Good	Occasional nonradicular pain relief of presenting symptoms; return to modified work	6(37.5%)
Fair	Some improved functional capacity still handicapped and unemployed	2(12.5%)
Poor	Continued objective symptoms of root involvement; additional operative intervention needed at the index level irrespective of length of postoperative followup	0(0%)

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