Comparison of discectomy with and without fusion in the surgical treatment of recurrent lumbar disc herniation.

Abstract

Objective: Recurrent intervertebral disc herniation is one of the most common problems encountered in spine surgery. This study aimed to compare the clinical outcomes of revision microdiscectomy and fusion surgeries in patients with recurrent lumbar disc herniation.

Methods: 276 patients who underwent surgery with same surgeon for recurrent lumbar disc herniation between January 2012 and December 2023 were retrospectively analyzed. The patients were divided into three groups: Group 1 (revision microdiscectomy, n = 129), Group 2 (discectomy with posterolateral fusion, n = 123), and Group 3 (discectomy with posterolateral fusion and posterior lumbar interbody fusion, n = 24). Clinical outcomes were evaluated using pre- and postoperative VAS and JOA scores.

Results: Postoperative radicular and lumbar VAS scores were significantly higher in Group 1 compared with Groups 2 and 3. The recovery rates were highest in Group 3 (77%) and Group 2 (75.5%), while Group 1 showed a lower recovery rate (71.8%). Postoperative JOA scores improved significantly in all groups, with Group 3 showing the greatest improvement in total JOA scores and SLR test results.

Discussion: Fusion procedures were associated with better pain control and functional improvement but higher risks of complications, including screw malposition and cage displacement. Both revision microdiscectomy and fusion surgeries are effective for recurrent lumbar disc herniation. Revision microdiscectomy is effective in young patients with limited back pain but carries risks of recurrence and instability. Fusion surgeries provide superior pain relief and functional outcomes but carry higher risks of complications and longer recovery times.

Conclusion: Both revision microdiscectomy and discectomy with fusion appear to be effective surgical options for the management of recurrent lumbar disc herniation. The selection of the surgical technique should be guided by patient-specific factors such as age and the predominance of low back versus radicular pain.