Recurrent Herniated Nucleus Pulposus

Recurrent Herniated Nucleus Pulposus

Recurrent Herniated Nucleus Pulposus

2

 

Axial-MRI-of-Recurrent-HNP

Statistically, Recurrent Herniated Nucleus Pulposus occur more commonly than hoped. When you have a Herniated Nucleus Pulposus,  the outer fibers of your disk, or the annulus has weakened allowing a tear, and subsequent rupture of the soft nucleus material out of the disk.  We can debate the cause of the weakening of the outer annulus,  but usually, it is a combination of wear on the crosslinking fibers for the outer fibro cartilage, combined with forces placed within the disk causing the softer inside (nucleus) to rupture, or herniate outside the fibers of the annulus.  More recent studies demonstrate that disruption of the endplate of the disk may also be the cause of herniations.

In most instances,  even with a large disk herniation,  the pain can subside without surgery.  The nucleus material that ruptured tends to dessicate, or dehydrate causing less pressure on the nerve elements over time.  Also,  the initial release of potentially pain generating materials from the disk gets absorbed, also lessening the pain.  But,  the disk, unfortunately, is now changed.

While the torn fibers of the annulus tries to repair itself,  the scar formation sealing the tear is never as strong as the original annulus.  It becomes a potential weak spot, and there is a concern for recurrent disk herniations through that same area of tear and scaring.

This Recurrent Herniated Nucleus Pulposus rate remains similar for both surgically treated, or non surgically treated disks, as the scarring of the annulus remains the same. Some of the so called surgical failures are actually patients that suffered from a Recurrent  Herniated Nucleus Pulposus,  and not necessarily because of failure of technique.   Recently,  there has been some effort on annulus repair , with sutures.  While there is some promise, the long term data is still not clear.

Recurrent Herniated Nucleus Pulposus can be treated similar to the initial disk herniation.  Activities modification,  use of medications,  physical therapy and steroid injections are common treatments prescribed.  If there is no improvement,  surgery can also be an option.

In the circumstance of Recurrent Herniated Nucleus Pulposus in a patient who had prior surgery at the same level,  sometimes a more aggressive surgical option, which includes removal of most of the disk and fusion may be recommended.  There are other stabilization procedures other than fusion,  but many of the insurance entities consider these procedures experimental.  

If you suspect you have a Recurrent Herniated Nucleus Pulposus,  please contact your physician to see what can be done to decrease your symptoms.

 

Citations

  • Huang W, Han Z, Liu J, Yu L, Yu X. Risk Factors for Recurrent Lumbar Disc Herniation: A Systematic Review and Meta-Analysis. Medicine (Baltimore). 2016 Jan;95(2):e2378. PubMed PMID: 26765413

Submit a Comment

    1. Hi! Often a recurrent disc needs reoperation if the patient is symptomatic and does not improve after several weeks. We do not recommend any sports while waiting for an improvement. If the patient improves, it will take several months for the annulus (the hard outer covering of the disc) to heal so more disc does not herniate. For both surgery, and waiting for the annulus to heal, 3 months without strenuous activity are ideal.

Leave a Reply

Your email address will not be published. Required fields are marked *

*
*

Disclosure Statement

The information provided on this website does not provide or should be considered medical advice. It is not a substitute for diagnosis or treatment of any condition. The information provided is for informational purposes only. You should not rely solely on the information provided on this website in making a decision to pursue a specific treatment or advice. You should consult directly with a professional healthcare provider.

As a condition of using the information on this website, ShimSpine and its physicians are not responsible for any advice, diagnosis, treatment or outcome you may obtain.

ShimSpine.com is completely self-funded. No outside funds are accepted or used. This website does not utilize paid advertising as a source of revenue.

This website is certified by Health On the Net Foundation. Click to verify. This site complies with the HONcode standard for trustworthy health information:
verify here.

Author and Contributor to www.Spine-Health.com – July, 2015

www.Spine-Health.com/author/john-h-shim-md-facs

Chief of Surgery, Mease Countryside and Mease Dunedin Hospitals, Safety Harbor and Dunedin, Florida. 2014-2016.

Orthopaedic Section Chief Mease Countryside Hospital; Safety Harbor, Florida Mease Dunedin Hospital; Dunedin, Florida.2008-2013

Board Member Morton Plant Mease Research Council

Co-Director of Mease Neuro-Ortho Spine Center Mease Dunedin Hospital; Dunedin, Florida.

One of “6 Spine Physicians Ranked #1 on Google” – December 2016

Top Ten Most Liked Spine Surgeons on the Internet – July 2016

2016 Spine Surgeons to Know list – January 2016

2014 Spine Specialists to know list – September 2014

One of Ten Leaders of Certified Spine Programs – December 2011

 

The Best Orthopedics in Tampa

The information provided on this website does not provide or should be considered medical advice. It is not a substitute for diagnosis or treatment of any condition. The information provided is for informational purposes only. You should not rely solely on the information provided on this website in making a decision to pursue a specific treatment or advice. You should consult directly with a professional healthcare provider.

As a condition of using the information on this website, ShimSpine and its physicians are not responsible for any advice, diagnosis, treatment or outcome you may obtain.

ShimSpine.com is completely self-funded. No outside funds are accepted or used. This website does not utilize paid advertising as a source of revenue.
Outpatient Spine Surgery Considerations. www.Spine-Health.com. January 2016.

What is Spinal Stenosis? www.Spine-Health.com. October 2015.

Surgeon insights on the Changing Landscape of Orthopedic Care. OrthopedicToday. June 2014

Chapter 33: Interspinous Spacers. Shim JH, Mazza JS, Kim DH Published in Minimally Invasive Percutaneous Spinal Techniques. Elsevier Health Sciences, Philadelphia, Pennsylvania. (Published 2011)

Chapter 35: Minimally Invasive Percutaneous Lumbar Fusion Technique.Shim JH, Mazza JS, Kim DH Published in Minimally Invasive Percutaneous Spinal Techniques. Elsevier Health Sciences, Philadelphia, Pennsylvania. (Published 2011)

March 2010 Minimally Invasive Transforaminal Lumbar Interbody Fusion American Academy of Orthopaedic Surgeons Annual Meeting New Orleans, Louisiana February 2010

February 2010 A Review of Dynamic Stabilization in the Lumbar Spine Selby Spine Symposium; Park City, Utah

November 2009 Lumbar Spinal Stenosis Community Based Lecture; Tampa, Florida

September 2009 Instructor/Proctor Minimally Invasive Lumbar Cadaver Lab; Tampa, Florida

February 2009 New Spinal Technology: Cervical Disc Replacement and Interspinous Spacers. Selby Spine Symposium; Park City, Utah

February 2008 The Degenerative Spine: The Role of Dynamic Lumbar Stablization and Interspinous Spacers Selby Spine Symposium; Park City, Utah

October 2008 Emerging Technology and Techniques in Spinal Surgery Orthopaedics in the 21st Century Symposium; Morton Plant Mease Healthcare; Largo, Florida

September 2007 Emerging Technology in Spinal Surgery Orthopaedics in the 21st Century Symposium; Morton Plant Mease Healthcare; Largo, Florida

October 2006 Emerging Technology and Techniques in Spinal Surgery Orthopaedics in the 21st Century Symposium; Morton Plant Mease Healthcare; Largo, Florida

May 2005 The Role of Kyphoplasty in the Treatment of Vertebral Compression Fractures Mease Neurosciences Symposium; Clearwater, Florida
Please note all articles, blogs and Q&A’s on this site are general information and are not to be used as medical advice for individuals. No specific diagnosis or treatment should be made based on this information. Only a physician can provide you with advice specific to your situation. Please followup with your physician if you would like to discuss your individual condition.

If you are having a medical emergency,  contact your Doctor immediately,  or go to the Emergency Room.
ShimSpine and ShimSpine.com is committed to honoring and respecting the privacy and anonymity of the individuals using its website(s) and/or services. The purpose of this Privacy Policy is to inform the individuals about the collection, processing and protection of information done by ShimSpine what information we collect, why we collect this information and how we use this information.

This Privacy Policy will be reviewed regularly to reflect the up-to-date practices of ShimSpine.