Factors associated with the recurrence of lumbar disk herniation: non-biomechanical-radiological and intraoperative factors

Abdallah A., Abdallah B. G.

NEUROLOGICAL RESEARCH, vol.45, no.1, pp.11-27, 2023 (SCI-Expanded) identifier identifier identifier

  • Publication Type: Article / Article
  • Volume: 45 Issue: 1
  • Publication Date: 2023
  • Doi Number: 10.1080/01616412.2022.2116525
  • Journal Indexes: Science Citation Index Expanded (SCI-EXPANDED), Scopus, BIOSIS, EMBASE, MEDLINE
  • Page Numbers: pp.11-27
  • Keywords: Recurrent lumbar disk herniation, non-biomechanical-radiological factors, intraoperative disk type, Modic changes, degenerative spine disease, RISK-FACTORS, FRAGMENT EXCISION, DISKECTOMY, MICRODISCECTOMY, OUTCOMES, SEQUESTRECTOMY, REOPERATION, EXPERIENCE, REVISION, REMOVAL
  • Bezmialem Vakıf University Affiliated: No


Background Recurrent lumbar disk herniation (RLDH) is one of the most undesirable complications following lumbar discectomy (LD). This study aimed to prospectively investigate the non-biomechanical-radiological and intraoperative factors affecting the recurrence after discectomy. Patients and Methods Data of 988 consecutive patients with Lumbar disk herniation (LDH) who underwent LD at our department for over 2 years (2014-2015) were prospectively collected. Patients who met our study criteria were included (n = 816). Patients were divided into the following groups; group 1 included patients with symptomatic RLDH within the first postoperative 2 years (PO24M), group 2 included patients with symptomatic RLDH after PO24M, and group 3 included patients without symptomatic RLDH/LDH. The preoperative non-biomechanical-radiological, surgical, and intraoperative characteristics were compared among the groups. Results A total of 842 LDHs in 816 (386 men and 430 women) patients received LD. The mean age was 46.9 years. The mean follow-up period was 72.8 months. The first recurrence rates within the first PO24M and after PO24M were 7.1% and 3.2%, respectively. Disks with Modic changes type-II and contained disks without fragments were associated with the short- and long-term RLDH [(p = 0.004; HR = 0.6); (p < 0.0001; HR = 0.14)] and [(p = 0.041; HR = 0.6); (p < 0.0001; HR = 0.16)], respectively. Conclusions Several radiological, surgical, and intraoperative factors can play a critical role in RLDH; therefore, the selection criteria of patients with LDH should be carefully considered for surgical treatment to obtain acceptable outcomes.