Surgical treatment of recurrent herniated discs of the lumbar spine depending on risk factors

Chekhonatsky VA, Kuznetsov AV, Usachev DYu, Zakharova NB, Chekhonatsky AA, Gorozhanin AV, Dreval ON. Surgical treatment of recurrent herniated discs of the lumbar spine depending on risk factors. Burdenko's Journal of Neurosurgery. 2024;88(4):31‑37. (In Russ., In Engl.)
https://doi.org/10.17116/neiro20248804131

Подписка 2025 Журнал «Вопросы нейрохирургии» имени Н.Н. Бурденко (Burdenko's Journal of Neurosurgery)

Использование инфографики авторами научных работ

Close metadata

MATERIAL AND METHODS

The study included 61 patients with recurrent intervertebral disc herniation. Thirty patients underwent repeated microdiscectomy without transpedicular fixation, 31 patients — resection of recurrent disc herniation with transpedicular fixation (PLIF technique). The control group included 63 patients without recurrent disc herniation. Mean follow-up period was 3.5 years.

RESULTS

Discectomy with transpedicular fixation is characterized by larger extent, prolonged surgery time and rehabilitation period. However, there is lower risk of recurrent disc herniation and CSF leakage. Repeated microdisectomy without transpedicular fixation is characterized by smaller extent and shorter surgery time, as well as faster recovery period. Nevertheless, we have higher risk of recurrent disc herniation and CSF leakage. We developed a method for assessing the probability of recurrent intervertebral disc herniation. This algorithm allows us to predict the probability of recurrent disc herniation in a particular patient with 86.7% accuracy.

CONCLUSION

We proposed an algorithm for choosing surgical treatment of recurrent disc herniation. Microdiscectomy without fixation is advisable for the risk of recurrent disc herniation <30%, discectomy with transpedicular fixation — for risk of disc herniation >30%.

Keywords:

recurrent intervertebral disc herniation

risk factors of recurrence

surgical treatment

recurrent intervertebral disc herniation

risk factors of recurrence

surgical treatment

Authors:

Chekhonatsky V.A.

Russian Medical Academy of Continuous Professional Education

ORCID: 0000-0001-6155-1154

Kuznetsov A.V.

Russian Medical Academy of Continuous Professional Education

ORCID: 0000-0002-9487-6008

Usachev D.Yu.

Russian Medical Academy of Continuous Professional Education;
Burdenko Neurosurgical Center

ORCID: 0000-0002-8924-7346

Zakharova N.B.

Razumovsky Saratov State Medical University

ORCID: 0000-0003-0289-3562

Chekhonatsky A.A.

Razumovsky Saratov State Medical University

ORCID: 0000-0003-3327-1483

Gorozhanin A.V.

Botkin Moscow City Clinical Hospital

ORCID: 0000-0002-3593-7034

Dreval O.N.

Russian Medical Academy of Continuous Postgraduate Education

ORCID: 0000-0002-8944-9837

Received:

18.02.2024

Accepted:

31.05.2024

Close metadata

References:

Shepard N, Cho W. Recurrent Lumbar Disc Herniation: A Review. Global Spine Journal. 2019;9(2):202-209. https://doi.org/10.1177/2192568217745063
Yaman ME, Kazanci A, Yaman ND, Bas F, Ayberk G. Factors that influence recurrent lumbar disc herniation. Hong Kong Medical Journal. 2017;23:258-263. https://doi.org/10.12809/hkmj164852
Chekhonatskii VA, Dreval ON, Kuznetsov AV, Chekhonatskii AA, Zaharova NB, Grihina EA, Gorozanin AV, Volna VV. The role of inflammatory mediators, growth factors and osteodystrophic processes in the development of recurrent herniated discs of the lumbar spine. Annals of clinical and experimental neurology. 2023;17(2):36-42. (In Russ.). https://doi.org/10.54101/ACEN.2023.2.5
Dreval ON, Kuznetsov AV, Chekhonatskii VA, Baskov AV, Chekhonatskii AA, Gorozanin AV. Pathogenetic aspects and risk factors for recurrent herniated disc of the lumbar spine. Spine Surgery. 2021;18(1):47-52. (In Russ.).
Dower A, Chatterji R, Swart A, Winder MJ. Surgical management of recurrent lumbar disc herniation and the role of fusion. Journal of Clinical Neuroscience. 2016;23:44-50. https://doi.org/10.1016/j.jocn.2015.04.024
Basankin IV, Porhanov VA, Gylzatiyn AA, Malahov SB, Tahmaziyn KK, Tomina MI, Shevchenko EG. Comparative evaluation of the effectiveness of transpedicular endoscopic sequestrectomy and microdiscectomy in the treatment of intervertebral hernias of the lumbar region with a high degree of migration. Burdenko’s Journal of Neurosurgery. 2020;84(6):15-25. (In Russ.).
Loparev EA, Klimov VS, Evsyukov AV. Reoperation after herniated disc removal in patients with lumbar degenerative disc disease. Spine Surgery. 2017;1(14):51-59. (In Russ.). https://doi.org/10.14531/ss2017.1.51-59
Wang JC, Dailey AT, Mummaneni PV, Ghogawala Z, Resnick DK, Watters 3rd WC, Groff MW, Choudhri TF, Eck JC, Sharan A, Dhall SS, Kaiser MG. Guideline update for the performance of fusion procedures for degenerative disease of the lumbar spine. Part 8: lumbar fusion for disc herniation and radiculopathy. Journal of Neurosurgery: Spine. 2014;21:48-53. https://doi.org/10.3171/2014.4.SPINE14271
Chekhonatskii VA, Dreval ON, Kuznetsov AV, Chekhonatskii AA, Gorozanin AV, Shestakov AA, Sidorenko VV. Modern principles of treatment of recurrent herniated discs of the lumbar spine (review). Saratov Journal of Medical Science. 2020;3(16):64-69. (In Russ.).
Makirov SK, Musa D, Ndandja DKCh, Chmutin GE, Kim AV, Hovrin DV, Otarov OB. Repeat discectomy and spinal fusion in thetreatment of recurrent lumbar disc herniation: systematic review of the literature. Spine Surgery. 2023;3(20):43-49. (In Russ.). https://doi.org/10.14531/ss2023.3.43-49
Kravtsov MN, Kruglov IA, Mirzametov SD, Seleznev AS, Alekseyeva NP, Manukovskiy VA, Gaidar BV, Svistov DV. Evaluation of the effectiveness of surgical methods for the treatment of recurrent lumbar disc herniation: a cohort retrospective study. Spine Surgery. 2021;2(18):34-43. (In Russ.). https://doi.org/10.14531/ss2021.2.34-43
Nikolaev NA. Quantitative assessment of treatment adherence in clinical medicine: protocol, procedure, interpretation. High-quality clinical practice. 2016;1:5-9. (In Russ.).
Grogan J, Nowicki BH, Schmidt TA, Haughton VM. Lumbar facet joint tropism does not accelerate degeneration of the facet joints. American Journal of Neuroradiology. 1997;18:1325-1329.
Mok FPS, Samartzis D, Karppinen J, Fong DYT, Luk KDK, Cheung KMC. Modic changes of the lumbar spine: Prevalence, risk factors, and association with disc degeneration and low back pain in a large-scale populationbased cohort. Spine Journal. 2016;16(1):32-41.
Siccoli A, Staartjes VE, Klukowska AM, Muizelaar JP, Schröder ML. Overweight and smoking promote recurrent lumbar disk herniation after discectomy. European Spine Journal. 2022;31(3):604-613. https://doi.org/10.1007/s00586-022-07116-y
NaPier Z, Kanim L EA, Nelson TJ, Salehi K, Arabi Y, Glaeser JD, Sheyn D, Metzger MF. The effect of insulin dependent diabetes on bone metabolism and growth after spinal fusion. Spine Journal. 2020;20(5):800-808. https://doi.org/10.1016/j.spinee.2019.11.011
Cao P, Chen Z, Zheng Y, Wang Y, Jiang L, Yang Y, Zhuang C, Liang Y, Zheng T,Gong Y, Zhang X, Wu W, Qiu S. Comparison of simple discectomy and instrumented posterior lumbar interbody fusion for treatment of lumbar disc herniation combined with Modic endplate changes. Chinese Medical Journal. 2014;127:2789-2794. https://doi.org/10.3760/cma.j.issn.0366-6999.20132087
Chekhonatskii VA, Dreval ON, Kuznetsov AV, Chekhonatskii AA, Gorozanin AV, Sidorenko VV. Analysis of the results of decompressive and decompressive-stabilizing operations in patients with single and repeated recurrences of herniated discs of the lumbar spine. Russian Neurosurgical Journal n.a. prof. A.L. Polenov. 2022;1:120-127. (In Russ.).
Fu TS, Lai PL, Tsai TT, Niu CC, Chen LH, Chen WJ. Long-term results of disc excision for recurrent lumbar disc herniation with or without posterolateral fusion. Spine. 2005;30(24):2830-2834. https://doi.org/10.1097/01.brs.0000190393.15369.94
Burak E, Guzey K, Feyza, Gulec I, Sahin T, Tufan A, Bas NS. The Importance of Spinopelvic Parameters in Recurrent Lumbar Disk Herniation. Clinical Spine Surgery. 2024;37(3):113-118. https://doi.org/10.1097/BSD.0000000000001546
Harada GK, Siyaji ZK, Mallow GM, Hornung AL, Hassan F, Basques BA, Mohammed HA, Sayari AJ, Samartzis D. Artificial intelligence predicts disk re-herniation following lumbar microdiscectomy: development of the «RAD» risk profile. European Spine Journal. 2021;30(8):2167-2175. https://doi.org/10.1007/s00586-021-06866-5