Surgery for Recurrent Disk Herniations

Surgery for Recurrent Disk Herniations

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Unfortunately, even after successful lumbar discectomy surgery,  there is between a 5% and 15% chance of a recurrent disk herniation at the same location. The reason is secondary to the nature,  and size of the lumbar disk.  Most disk herniations are pieces of annulus, endplate, and or nucleus elements of the disk.  The fragments, however, are only a very small piece compared to the whole disk. No matter how much disk is removed during the original discectomy surgery,  there is always more disk material available to herniate.

In addition to the amount of disk material still present,  the hole where the disk material herniated is still present.  Even though there is some scar tissue and repair of the hole,  it will never be as strong as the original annulus.  Just so it is clear,  once a disk herniates,  it will always have the 5%-15% chance of re-herniation,  with or without surgery.

If you have a recurrent disk herniation after the prior discectomy surgery,  most physicians will still try to treat the disk herniation non-surgically.

If you can no longer tolerate the pain,  there are different surgical options on how to handle your disk herniation.

  1. Provided this is only the first recurrence,  many Surgeons will consider doing just a repeat discectomy.  The results for the proper patient is similar to the original surgery.  Some studies have suggested that central recurrent disk herniations at L4-5 should also be fused at the same time,  as the L4-5 level is most associated with discogenic back pain,  and development of instability.
  2. After multiple recurrent disk herniations at the same level,  the standard answer is to consider repeat discectomy with fusion.  Successful fusion will prevent further recurrent disk herniations at the disk level, as most of the disk is removed,  and there will no longer be motion at that disk level.   Fusions,  however,  have associated complications,  including fusion failure,  hardware failure, and potential for accelerated degeneration of the disk levels above/below the level ( Adjacent Segment Disease).  The surgeon must consider the possibilities before pursuing the fusion, depending on factors such as age,  activity level,  medical condition,  etc.
  3. A minority of Surgeons will recommend repeat discectomy and Total Disk Replacement.  The rationale is to remove the disk,  thus improving the leg pain,  as well as replacing the disk to prevent the Adjacent Segment Disease.  While the principles seem logical,  it usually requires both an incision on the back,  to remove the disk,  as well as an abdominal incision to replace the disk.  The anterior abdominal incision has multiple associated risks,  and the long term efficacy of Lumbar Total Disk replacement is still being challenged.
  4. Certain surgeons are now performing the repeat discectomy,  but to protect the disk level bay placing posterior interspinous,  or posterior intralaminar stabilization devices.  This technology has been used in Europe for more than 15 years,  and has been FDA approved for use in one or two level lumbar spinal stenosis.***  The devices provide stability without needing a fusion.  This technique has its advantage in that it can be easily converted to a fusion  if necessary into the future,  and can be performed on a minimal access,  outpatient basis.  For recurrent lumbar discectomy,  it has not be officially studied and it considered an off label use of the device.

If you have a recurrent lumbar disc herniation after the prior successful discectomy surgery,  the chances are good that you will have a successful repeat surgical procedure.  But know that there are different surgical options.  Please discuss them with your Surgeon.

***  Disclosure statement from Paradigm Spine, LLC.  “The Coflex interlaminar Technology is an interlaminar stabilization device that is indicated for the use in one or two level lumbar stenosis from L1-L5 in skeletally mature patients with at least moderate impairment in function, who expericnce relief in flexion from their symptoms of leg/buttock/groin pain, with or without back pain, and who have undergone at least 6 months of non-operative treatment.  The Coflex is intended to be implanted midline between adjacent lamina of 1 or 2 contguous lumbar motion segments.  Interlaminar stabilization is performed after decompression of stenosis at the affected level(s).”

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. I have a reherination, after microdisectomy in December 2017. I am having a second microdisectomy. What is the chance of reherination after the second operation?
    I have read reports that there is no accepted protocol for the second microdisectomy.

    Los Angeles, CA.

    1. Reherniation is, unfortunately, a chance that is taken whenever a discectomy is done. The chances of reherniation are dependent on post-op activity, the size of the original herniation and how big the opening in the annulus is (the hard out covering of the disc) and time. The goal is to have the annulus heal before another piece of disc pops out. Reherniation is more likely to happen with smoking and obesity as there is less healing with smoking and more pressure on the disc with excess weight. The chances of another reheriation is about the same after the second surgery and most surgeons go the route of fusion if it happens the second time.

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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.

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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
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