Microdiscectomy for recurrent L5–S1 disc herniation

• DOI: 10.1007/s00586-013-3114-9
• Publication Date: 2013-11-22T06:21:02Z
• Authors: Pedro Berjano; Matteo Pejrona; Marco Damilano
• Keywords: Disc herniation; Intervertebral Disc Displacement; Lumbar disc herniation

Recurrent lumbar disc herniation (RLDH) is a complication in the surgery for lumbar disc herniation (LDH). In different cohorts, a range between 0.5 [3] and 25 % [5] of patients primarily operated for LDH suffered from RLDH (symptomatic or asymptomatic). Many of them needed repeat surgery. Risk factors for RLDH seem to include obesity, smoking and persistence of weight lifting after first surgery [2, 4–6]. Male patients who undergo surgery when still young carry a higher risk of recurrence [3]. Surgical management and decisions are variable, and they depend on many aspects: patient age, level of discopathy, foraminal stenosis and segmental instability. There is good common agreement about the indication of selective excision of the prolapsed disc in cases of first recurrence of disc herniation, unless instability or significant chronic low back pain emerging from the affected disc is present [1, 5, 7]. In the remaining cases, dynamic stabilization or, more commonly, spinal fusion is frequently indicated [7].