Background
Recurrent back and/or leg pain after primary lumbar discectomy is not uncommon. Some spine surgeons believe that fusion is necessary for treating disc reherniation. As repeated discectomy requires the removal of more disc material and posterior elements, such as lamina or facet joint, further invasion at the same surgical level can increase the risk of segmental instability.
Patients and methods
A total of 20 patients (12 men, eight women) with recurrent lumbar disc herniation were treated via transforaminal lumber interbody fusion. The mean age at the time of operation was 46.6 years (30–62 years). The primary procedures included discectomy with unilateral hemilaminectomy in nine and discectomy with bilateral laminectomy in 11 patients. The time from the primary surgery to that of recurrence averaged 10.6 months (range, 6–18 months). The levels of recurrent disc herniation were nine cases at L4–L5 (six ipsilateral and three contralateral) and 11 at L5–S1 (seven ipsilateral and four contralateral).
Results
The mean follow-up period was 22.8 months (18–30 months). The mean duration of the operation was 161.75 min (130–190–min), mean intraoperative blood loss was 325 ml (250–500), and mean duration of hospital stay was 4.15 days (3–7 days). At a minimum of 12 months of follow-up, all cases appeared to have solid fusions.
Conclusion
Transforaminal lumbar interbody fusion technique is an effective procedure with satisfactory clinical results for the treatment of recurrent lumbar disc herniation. The approach achieves a biomechanically stable spine, as it restores the segmental lordosis and has low complication rates.