Recurrent Lumbar Disc Herniation in Results of Revision Discectomy To Postoperative Status

Abstract

Background: Recurrent lumbar disc herniation (RLDH) is one of the most common spinal disorders following dise surgery. It is a major disabling condition as it impairs significantly with daily activities. But the management of recurrent lumbar disc herniation remains still controversial. Aim: To evaluate the recurrent lumbar disc herniation in results of revision discectomy to postoperative status. Methods: This prospective interventional study was conducted in department of Orthopaedic Surgery, BSMMU, Dhaka from October 2017 to September 2019. A total of 22 cases of RLDH having the inclusion criteria were taken as sample after diagnosing clinically, radiologically and with MRI. Outcome of low back pain (LBP) and radicular pain was measured by visual analogue score (VAS) and overall clinical outcome by Japanese Orthopaedic Association (JOA) score. Statistical analysis was done by using statistical package for social science (SPSS-25). The results were expressed as frequency, percentage and mean ± SD. Level of significance was calculated at confidence interval of 95% and p< 0.05.

Results: Follow up period was at least 06 months. Age of patients ranges from 35-70 years with mean age 51.1±19.7 years; 68.2% were male and 31.8% were female. Heavy workers were 54.5%, light workers 18.2% and house wives 27.3% with L₄-L₅ level involvement in 54.5% patients and L₅-S₁ in 45.5% patients. 77.3% subjects had BMI >30 kg/m² and 22.7% had ≤30 kg/m² with mean BMI 31.2±1.5 kg/m². In this study, Tobacco, diabetes and hypertension were found highly associated with recurrent disc herniation. 14 (63.6%), 11 (50%) and 13 (59.1%) patients were found as tobacco users, diabetic and hypertensive. In this study, interval between primary discectomy and RLDH was 6-12 months in 8 (36.4%) patients, 13-24 months in 10(45.45%), 25-36 months in 3(13.64%) and >36 months in 1(4.55) patient with mean interval 17.18±8.47 months. Majority (77.3% and 54.5%) of the study subjects had preoperative VAS score 7-10 and postoperative VAS score was 1 to 3 respectively. Pre and postoperative mean (+ SD) VAS score was 7.86±1.36 and 2.77±1.86 respectively. This indicated a significant difference between the two groups. Majority (72.7% and 63.2%) of the study subjects had preoperative VAS score 7-10 and postoperative VAS score was 1 to 3 respectively. Pre and postoperative mean (+ SD) VAS score was 7.5911.64 and 1.95+1.65 respectively. This indicated a significant difference between the two groups. In this study, only 4 (18.18%) patients developed postoperative complications. Among them, 1(4.55%) patient developed postoperative instability, 1 (4.55%) patient developed dural tear & transient neurological deficit and 2 (9.09%) patients developed postoperative superficial wound infection.To determine the surgical outcome of the study, excellent and good grades were treated as satisfactory, fair and poor grades were treated as unsatisfactory. So, a total number of 20 (90.9%) patients were in the satisfactory group and only 2 (9.1%) patients were in the unsatisfactory group. Conclusions: After analyzing the results of present study, it can be concluded that revision discectomy is an effective procedure with very satisfactory functional results for management of patients with recurrent lumbar disc herniation.