Tag: recurrent disc herniation

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Risk Factors Associated With Revision Microdiscectomy or Subsequent Spinal Fusion Within Two Years of Index Lumbar Microdiscectomy

Spine 2025;50:1392–1399

This large retrospective study found that within two years of lumbar microdiscectomy, 5.5% required revision surgery and 6.6% required spinal fusion. Age 40–59, female sex, and at least one Charlson Comorbidity Index (CCI) comorbidity significantly increased the risk of subsequent fusion, but not revision microdiscectomy.

Revision microdiscectomy rates after index lumbar microdiscectomy were 3.5% at one year and 5.5% at two years.

• Lumbar fusion rates were 2.9% at one year and 6.6% at two years after index surgery.

• Age 40–59, female sex, and presence of at least one Charlson Comorbidity Index (CCI) comorbidity significantly increased risk of lumbar fusion, but not revision microdiscectomy.

• Having ≥1 CCI comorbidity increased the likelihood of needing fusion by about 80%.

• Specific comorbidities (e.g., congestive heart failure, peripheral/cerebrovascular disease, diabetes) were strong predictors for time-to-fusion.

• Age, sex, and CCI score were not predictive of time-to-revision microdiscectomy.

• Results suggest CCI may help identify patients at higher risk for spinal fusion after microdiscectomy.

• Findings may guide surgeons in perioperative decision-making and patient counseling.

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Anterior lumbar discectomy and fusion for acute cauda equina syndrome caused by recurrent disc prolapse

J Neurosurg Spine 27:352–356, 2017

There is a lack of information and consensus regarding the optimal treatment for recurrent disc herniation previously treated by posterior discectomy, and no reports have described an anterior approach for recurrent disc herniation causing cauda equina syndrome (CES). Revision posterior decompression, irrespective of the presence of CES, has been reported to be associated with significantly higher rates of dural tears, hematomas, and iatrogenic nerve root damage.

The authors describe treatment and outcomes in 3 consecutive cases of patients who underwent anterior lumbar discectomy and fusion (ALDF) for CES caused by recurrent disc herniations that had been previously treated with posterior discectomy. All 3 patients were operated on within 12 hours of presentation and were treated with an anterior retroperitoneal lumbar approach. Follow-up ranged from 12 to 24 months. Complete retrieval of herniated disc material was achieved without encountering significant epidural scar tissue in all 3 cases. No perioperative infection or neurological injury occurred, and all 3 patients had neurological recovery with restoration of bladder and bowel function and improvement in back and leg pain.

ALDF is one option to treat CES caused by recurrent lumbar disc prolapse previously treated with posterior discectomy. The main advantage is that it avoids dissection around epidural scar tissue, but the procedure is associated with other risks and further evaluation of its safety in larger series is required.

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