Our Summary

This study compared two types of surgery for patients suffering from repeated lumbar disc herniation (a common back condition that can require reoperation). It looked at 90 patients who had previously had a lumbar microdiscectomy (a surgery to remove part of a herniated disc in the lower back) and were now experiencing a new herniation.

The patients were split into two groups. Group A had the standard repeat operation, while Group B had a repeat operation along with an additional procedure called transforaminal lumbar interbody fusion (MIS TLIF). This procedure involves using a minimally invasive technique to fuse together the problematic vertebrae in the lower back.

The researchers collected data on a range of factors including pain levels, operation time, blood loss, length of hospital stay, costs, and complications.

The results showed no significant difference in overall postoperative outcomes between the two groups. However, Group A patients experienced more lower back pain after surgery. Additionally, six people in this group needed further surgery. This group also had higher rates of complications including dural rupture (a tear in the protective membrane of the spinal cord) and postoperative neurological impairment.

Patients in Group A had less blood loss during surgery, but their operations took longer and they stayed in hospital for a longer period after surgery.

The study concluded that revision microdiscectomy is effective for patients with repeated lumbar disc herniation, but the additional MIS TLIF procedure can reduce the risk of complications, lower back pain, and the need for further surgery.

FAQs

  1. What is the difference between a lumbar microdiscectomy and a transforaminal lumbar interbody fusion (MIS TLIF) procedure?
  2. How did the outcomes of the standard repeat operation compare to those of the repeat operation with the additional MIS TLIF procedure?
  3. Did the additional MIS TLIF procedure affect the operation time, blood loss, or length of hospital stay for patients?

Doctor’s Tip

A helpful tip a doctor might tell a patient about microdiscectomy is that in cases of repeated lumbar disc herniation, considering additional procedures like transforaminal lumbar interbody fusion (MIS TLIF) along with the microdiscectomy may reduce the risk of complications, lower back pain, and the need for further surgery. It is important to discuss all treatment options with your doctor to determine the best course of action for your individual situation.

Suitable For

Patients who are typically recommended microdiscectomy are those who have a herniated disc in the lower back that is causing symptoms such as lower back pain, leg pain, and numbness or weakness in the legs. These patients may have already tried conservative treatments such as physical therapy, medication, and injections without success. In cases where the herniated disc is causing significant pain and disability that is not responding to conservative treatments, a microdiscectomy may be recommended to alleviate symptoms and improve quality of life.

Timeline

Before the microdiscectomy:

  • Patient experiences symptoms of a herniated disc such as lower back pain, leg pain, numbness, or weakness
  • Patient undergoes diagnostic tests such as MRI or CT scan to confirm the diagnosis
  • Patient may try conservative treatments such as physical therapy, medications, or injections to manage the symptoms

After the microdiscectomy:

  • Patient undergoes surgery to remove part of the herniated disc causing the symptoms
  • Recovery period involves pain management, physical therapy, and gradually increasing activity levels
  • Patient may experience some pain or discomfort after surgery, but this should improve over time
  • Follow-up appointments with the surgeon to monitor progress and address any concerns
  • Overall, the goal of the microdiscectomy is to relieve the symptoms caused by the herniated disc and improve the patient’s quality of life.

What to Ask Your Doctor

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

  1. What are the risks and benefits of microdiscectomy compared to other surgical options for my condition?
  2. What is the success rate of microdiscectomy for patients with repeated lumbar disc herniation?
  3. Will I need any additional procedures during the surgery, such as transforaminal lumbar interbody fusion (MIS TLIF)?
  4. What are the potential complications of microdiscectomy, and how likely are they to occur?
  5. How long is the recovery time after microdiscectomy, and what can I expect in terms of pain management and rehabilitation?
  6. Are there any lifestyle changes or precautions I should take after the surgery to prevent future disc herniation?
  7. How experienced are you in performing microdiscectomy procedures, and what is your success rate with this surgery?
  8. What is the typical outcome for patients who undergo microdiscectomy, and what are the chances of needing further surgery in the future?
  9. Are there any alternative treatments or non-surgical options that I should consider before deciding on microdiscectomy?
  10. How long do you recommend waiting before considering a repeat microdiscectomy if my symptoms persist or worsen after the initial surgery?

Reference

Authors: D’Oria S, Giraldi D, Murrone D, Salamone GG, Tomatis A, Colamaria A, Carbone F, Rossitto M, Fanelli V. Journal: J Am Acad Orthop Surg. 2023 Nov 15;31(22):1157-1164. doi: 10.5435/JAAOS-D-23-00123. Epub 2023 Aug 8. PMID: 37561938