Early Lumbar Disc Reherniation After Partial Discectomy
In this study, the records of 1,320 patients were reviewed to look for cases of recurrent lumbar disc herniation. All patients were treated with a subtotal lumbar discectomy (SLD). This operation removes the entire soft nucleus (center) of the protruding disc. The outer covering called the annulus remains in place.
There is some question about whether just removing the disc fragment is better than doing a SLD. There is also concern that fragments may be left behind that could cause problems later when any part of the disc remains.
Reviewing a large number of patients who had a SLD will help show if SLD is an acceptable way to treat disc herniation. Out of the 1,320 records, 14 cases of reherniation were found. They had to have occurred in the first year after the procedure to be counted as a complication. This is a low rate of complications of this type (about one per cent).
All reherniations were at the same level as the first herniation. Some were reherniated in a different direction. Ten of the 14 patients reported some traumatic event that caused the reherniation. These events included lifting, twisting, jogging, falling, and driving over a deep pothole in the road.
The group of patients with reherniations was compared to another (control) group of patients. The control group did not have any problems after this same surgery. The researchers compared results of the clinical exam and operative notes for both groups. Disc material removed was also examined and classified for comparison.
Type of disc defect was not linked with reherniation. The authors report the main difference between the groups was the amount of neurologic involvement before surgery. The reherniation group had a more significant amount of motor and sensory loss.
These problems present as numbness, tingling, weakness, and muscle atrophy (wasting). They occur as a result of the disc pressing on the nerve root. Sometimes the damaged disc leaks irritating chemicals that can cause these same symptoms.
The authors concluded that SLD is a safe and effective way to treat a herniated disc. The incidence of disc reherniation was very low. However, the surgeon should pay attention to any patient who reports new symptoms after a specific event or recurrent trauma. This could be a sign of reherniation.
Glenn D. Wera, MD, et al. Failure Within One Year Following Subtotal Lumbar Discectomy. In Journal of Bone and Joint Surgery. January 2008. Vol. 90. No. 1. Pp. 10-15.