Factors associated with the recurrence of lumbar disk herniation: non-biomechanical–radiological and intraoperative factors

ABSTRACT

Background

Recurrent lumbar disk herniation (RLDH) is one of the most undesirable complications following lumbar discectomy (LD). This study aimed to prospectively investigate the non-biomechanical–radiological and intraoperative factors affecting the recurrence after discectomy.

Patients and Methods

Data of 988 consecutive patients with Lumbar disk herniation (LDH) who underwent LD at our department for over 2 years (2014–2015) were prospectively collected. Patients who met our study criteria were included (n = 816). Patients were divided into the following groups; group 1 included patients with symptomatic RLDH within the first postoperative 2 years (PO24M), group 2 included patients with symptomatic RLDH after PO24M, and group 3 included patients without symptomatic RLDH/LDH. The preoperative non-biomechanical–radiological, surgical, and intraoperative characteristics were compared among the groups.

Results

A total of 842 LDHs in 816 (386 men and 430 women) patients received LD. The mean age was 46.9 years. The mean follow-up period was 72.8 months. The first recurrence rates within the first PO24M and after PO24M were 7.1% and 3.2%, respectively. Disks with Modic changes type-II and contained disks without fragments were associated with the short- and long-term RLDH [(p = 0.004; HR = 0.6); (p < 0.0001; HR = 0.14)] and [(p = 0.041; HR = 0.6); (p < 0.0001; HR = 0.16)], respectively.

Conclusions

Several radiological, surgical, and intraoperative factors can play a critical role in RLDH; therefore, the selection criteria of patients with LDH should be carefully considered for surgical treatment to obtain acceptable outcomes.

Abbreviations

ANOVA: A one-way analysis of variance, CIs: 95% confidence intervals, HR: Hazard ratio, LD: Lumbar discectomy, LDH: Lumbar disc herniation, LF: ligamentum flavum, MRI: Magnetic resonance imaging, MC-I: Modic changes type I, MC-II: Modic changes type II, MC-III: Modic changes type III, n: Number, ODI: Oswestry Disability Index, OR: Odds ratio, p-value: Probability value, PO: Postoperative, Pre: Preoperative, Pts: Patients, RLDH: Recurrent lumbar disc herniation, RR: Relative/risk ratio, SPSS: Statistical package for the social science, T1WIs: T1-weighted images, T2WIs: T2-weighted images, VAS: Visual analog scale.

KEYWORDS:

• Recurrent lumbar disk herniation
• non-biomechanical–radiological factors
• intraoperative disk type
• Modic changes
• degenerative spine disease

Disclosure statement

The authors have not reported any conflict of interest regarding this article.

Statement of Authorship

AA: Conceptualization, Methodology, Software, Data collection, Supervision, Formal analysis, Statistical analysis, Literature review, Visualization, Investigation, Writing – Original draft, Supervision, Writing – Review, and Validation.

BGA: Data collection, Review, Validation, and Literature review.

Additional information

Funding

This prospective study was approved under decision number: (14207/2015) by the medical ethics committee of the University of Health Sciences–Bakırköy Research and Training Hospital for Neurology Neurosurgery, and Psychiatry (BRSHH); in Istanbul-Turkey. Name of the Department and Institution in which the work was done: Department of the Neurosurgery University of Health Sciences–BRSHH Hospital.

Notes on contributors

Anas Abdallah

Anas Abdallah currently works as an associate professor in Neurosurgery and Spine surgery, at the Department of Neurosurgery, Istanbul Training and Research Hospital, Istanbul-Turkey. Anas does research in Neurosurgery, Neurovascular Surgery, Spine Surgery, and Neurooncology. Their most recent publication is “Association between Subarachnoid Hemorrhage-Induced Hydrocephalus and Hydromyelia: Pathophysiological Changes Developed in an Experimental Model”. Up-to-date, Anas has 50 published articles in journals indexed by the PUBMED index. He was the first author in 43 out of these 50 published articles. Besides 37 articles published in other journals.

Betül Güler Abdallah

Betül Güler Abdallah currently works as a specialist Nurse in Surgical diseases and Neuro-ICU, at the AMATEM Unit, Department of Psychiatry, University of Health Sciences, Bakırköy Research and Training Hospital for Neurology Neurosurgery, and Psychiatry, Istanbul-Turkey. Betül does research in Nursing, Infection, Neurosurgery, Neurovascular Surgery, Spine Surgery, and Neurooncology. Their most recent publication is “Management of myxopapillary ependymoma: a retrospective study from three institutions”. Up-to-date, Betül has 15 published articles in journals indexed by the PUBMED index.