Outcome analysis of reoperations after lumbar discectomies : a report of 22 patients

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Our aim was to analyse causes for persistence of pain after lumbar discectomy andoutcome of reoperations. Out of 37 reoperated patients, 22 with a minimum follow-upperiod of one year were included in this retrospective study concerning the years 1993to 2000. All patients had previously undergone laminotomy and discectomy and fusionwas not required during second operations. Outcome was evaluated according to themodified criteria of Kawabata et al.. Overall incidence of reoperation was 6.5%.Reoperations were performed because of recurrent disc herniation in 9 patients,epidural fibrosis in 8, and de novo disc herniation at a different level in 5. Contrastenhanced computerized tomography was used in 17 patients and this might be thereason for misdiagnosis of recurrent disc herniation in the two patients with epiduralfibrosis. In patients with de novo disc herniation, symptoms recurred earlier. In 20patients, satisfactory relief of pain, as well as better outcome could be achieved (p<0.05),but no significant improvement in neurological deficits was observed. Excellent resultswere obtained more in patients with recurrent disc herniation and poor outcomescorrelated with long (> 1 year) time intervals for onset of recurrent sciatica (p<0.05).However, patients with epidural fibrosis were also glad postoperatively for decreasedpain severity. Only co-existence of epidural fibrosis and de novo disc herniationpredicted an inferior outcome. Although recurrent disc herniation seemed to respondbest to surgical treatment, we recommend reoperation when objective preoperativefindings indicate the presence of surgically correctable compression regardless of itstype.
神戸大学の論文

Outcome analysis of reoperations after lumbar discectomies : a report of 22 patients

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