The Chance of Lumbar Discectomy Reoperation
In general appropriate properly selected patients do well with lumbar discectomy surgery. By definition, a properly selected patient is one who has a well defined disk herniation on diagnostic testing, with corresponding physical examination findings of neurotension (straight leg raise findings), and identified loss of sensation, reflex changes and/or weakness that follows a specific nerve distribution. If that person does not improve despite 6-8 weeks of time and non surgical treatments, there is usually a 95% success rate in terms of reduction of symptom.
The concern is about potential for repeat surgery in the future. It is a possibility, and many think repeat surgery is inevitable. The real data is not that bleak.
In 2000, the Spine Patient Outcomes Research Trial (SPORT) started collecting data on patients undergoing various lower back spine surgeries. There been many articles written about the results of the study. Recently, in the August 2015 Journal of Bone and Joint Surgery, Leven et al reviewed the data on the “Risk Factors for Reoperation in Patients Treated Surgically for Intervertebral Disc Herniation”.
The article was full of take home points.
- At 8 years, there was a 15% reoperation rate.
- 62% of the operations were for recurrent disk herniations at the same level
- 25% of the operations were secondary to complications from the initial operation
- 11% of the operations were secondary for a new condition.
- Older patients were less likely to have reoperations
While 15% still seems like a large number, it is definitely less than what most of my patients think will happen.
If you are ever asked the chance for repeat spine surgery after lumbar discectomy, it is perfectly fine to say “you are less likely to need further spine surgery after discectomy”. While there are no guarantee’s, for the properly selected, and counseled patient, lumbar discectomy is a reasonable option.