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factors_related_to_the_primary_discectomy_in_recurrent_lumbar_disc_herniation

Factors Related to the Primary Discectomy in Recurrent Lumbar Disc Herniation

The degree of disc removal did not influence the outcome or complication rate in Fountas et al., clinical series 1)

For Carragee et al., the more aggressive removal of remaining intervertebral disc material may decrease the risk of reherniation, but the overall outcome was less satisfactory, especially during the first year after surgery 2).


A systematic review of the literature suggests that conservative discectomy may result in shorter operative time, quicker return to work, and a decreased incidence of long-term recurrent low back pain but with an increased incidence of recurrent disc herniation. Prospective randomized trails are needed to firmly assess this possible benefit. 3).

The question remains how to balance the desire for maintaining disc height with minimizing the risk for reherniation 4).

Annulus defect

McGirt et al., found that larger annulus defects and smaller percentage of disc removed during primary surgery, rather than absolute volume as reported in previous studies, were associated with an increased risk of recurrent lumbar disc herniation while more aggressive removal contributed to accelerated disc height loss 5).


The addition of a bone-anchored annular closure device (ACD) in patients with large annular defects following lumbar discectomy reduces the risk of reherniation and reoperation, and has a similar safety profile over 3-year follow-up compared with lumbar limited discectomy only 6).

see Barricaid.

References

1)
Fountas KN, Kapsalaki EZ, Feltes CH, et al. Correlation of the amount of disc removed in a lumbar microdiscectomy with long-term outcome. Spine (Phila Pa 1976). 2004;29:2521–2526.
2)
Carragee EJ, Spinnickie AO, Alamin TF, Paragioudakis S. A prospective controlled study of limited versus subtotal posterior discectomy: short-term outcomes in patients with herniated lumber intervertebral discs and large posterior anular defect. Spine (Phila Pa 1976). 2006;31:653–657.
3)
Walters WC, 3rd, McGirt MJ. An evidence-based review of the literature on the consequences of conservative versus aggressive discectomy for the treatment of primary disc herniation with radiculopathy. Spine J. 2009;9:240–257.
4)
Shepard N, Cho W. Recurrent Lumbar Disc Herniation: A Review. Global Spine J. 2019 Apr;9(2):202-209. doi: 10.1177/2192568217745063. Epub 2017 Dec 18. Review. PubMed PMID: 30984501; PubMed Central PMCID: PMC6448208.
5)
McGirt MJ, Eustacchio S, Varga P, et al. A prospective cohort study of close interval computed tomography and magnetic resonance imaging after primary lumbar discectomy: factors associated with recurrent disc herniation and disc height loss. Spine (Phila Pa 1976). 2009;34:2044–2051.
6)
Kienzler JC, Klassen PD, Miller LE, Assaker R, Heidecke V, Fröhlich S, Thomé C; Annular Closure RCT Study Group. Three-year results from a randomized trial of lumbar discectomy with annulus fibrosus occlusion in patients at high risk for reherniation. Acta Neurochir (Wien). 2019 May 15. doi: 10.1007/s00701-019-03948-8. [Epub ahead of print] PubMed PMID: 31089894.
factors_related_to_the_primary_discectomy_in_recurrent_lumbar_disc_herniation.txt · Last modified: 2019/05/17 08:14 by administrador