Our Summary

This research paper analyzes the effectiveness of two surgical treatment options for recurring lumbar disc herniation, a condition where a disc in the lower back herniates, or slips out of place, more than once. These two options are a repeat discectomy (removing the herniated disc) or a repeat discectomy supplemented with fusion (joining two or more vertebrae together).

The researchers looked at 15 previous studies, which included a total of 1,405 patients who had either undergone fusion or repeat discectomy. They found that the average time for the disc to herniate again was about 54 months, and the patients were followed up for an average of 40 months.

They found no significant difference between the two methods in terms of how often additional operations were needed. Additionally, patient-reported outcomes, such as levels of back and leg pain, disability, and satisfaction with the surgery, were also similar between the two groups.

In conclusion, the study suggests that both repeat discectomy and fusion are equally effective treatment options for one-time recurring lumbar disc herniation. However, the researchers suggest that more long-term, randomized controlled trials should be done to further validate these findings.

FAQs

  1. What are the two surgical treatment options for recurring lumbar disc herniation discussed in the research paper?
  2. What were the main findings regarding the effectiveness of repeat discectomy versus fusion in the treatment of recurring lumbar disc herniation?
  3. What are the researchers’ suggestions for future studies on this topic?

Doctor’s Tip

A helpful tip a doctor might tell a patient about discectomy is to follow post-operative instructions carefully, including avoiding heavy lifting and strenuous activities for a certain period of time to allow for proper healing. It is also important to participate in physical therapy and follow up appointments to ensure a successful recovery. Additionally, maintaining a healthy weight and practicing good posture can help prevent future disc herniation.

Suitable For

Patients who are typically recommended for discectomy are those who have recurring lumbar disc herniation, where the disc in the lower back slips out of place more than once. These patients may experience symptoms such as back and leg pain, numbness, weakness, and difficulty performing daily activities. The decision to undergo discectomy is usually made after conservative treatments such as physical therapy, medications, and injections have not provided relief. Additionally, patients with severe symptoms, significant neurological deficits, and a confirmed diagnosis of lumbar disc herniation on imaging studies are also good candidates for discectomy.

Timeline

Before the discectomy:

  1. Patient experiences recurring lumbar disc herniation, with symptoms such as back pain, leg pain, and numbness.
  2. Patient undergoes initial discectomy surgery to remove the herniated disc.
  3. Over time, patient’s symptoms return and the disc herniates again.

After the discectomy:

  1. Patient consults with a healthcare provider to discuss treatment options for recurring disc herniation.
  2. Patient undergoes either a repeat discectomy or a repeat discectomy supplemented with fusion surgery.
  3. Patient is followed up for an average of 40 months to monitor their symptoms and outcomes.
  4. Researchers find no significant difference between the two surgical methods in terms of reoperation rates and patient-reported outcomes.
  5. Patient experiences relief from symptoms and improved quality of life following the surgery.
  6. Researchers suggest more long-term, randomized controlled trials to further validate the effectiveness of these surgical options.

What to Ask Your Doctor

Some questions a patient should ask their doctor about discectomy include:

  1. What are the potential risks and complications associated with a repeat discectomy or a repeat discectomy supplemented with fusion?
  2. How long is the recovery period for each surgical option, and what can I expect in terms of post-operative pain and rehabilitation?
  3. What are the success rates of each procedure in terms of relieving my symptoms and preventing future herniation?
  4. Will I need physical therapy or other forms of rehabilitation after the surgery, and if so, what does that entail?
  5. How long will it take for me to return to my normal activities, such as work and exercise, after the surgery?
  6. Are there any specific factors about my condition or medical history that may make one surgical option more suitable for me than the other?
  7. What are the potential long-term effects of each procedure on my spine and overall back health?
  8. Are there any non-surgical treatment options that I should consider before undergoing surgery?
  9. How often will I need to follow up with you after the surgery, and what signs or symptoms should I watch out for that may indicate a complication?
  10. Can you provide me with any additional resources or information to help me make an informed decision about which surgical option is best for me?

Reference

Authors: Kerezoudis P, Goncalves S, Cesare JD, Alvi MA, Kurian DP, Sebastian AS, Nassr A, Bydon M. Journal: Clin Neurol Neurosurg. 2018 Aug;171:70-78. doi: 10.1016/j.clineuro.2018.05.023. Epub 2018 May 29. PMID: 29864645