Contralateral recurrent lumbar disc herniation. Results of discectomy compared with those in primary herniation

G Cinotti, S Gumina, G Giannicola, F Postacchini
Spine 1999 April 15, 24 (8): 800-6

STUDY DESIGN: The surgical outcomes of patients who underwent discectomy for contralateral recurrent herniation and primary herniation were evaluated.

OBJECTIVE: To assess whether the clinical results in patients undergoing surgery for contralateral recurrent disc herniation may be as good as those reported after primary discectomy.

SUMMARY OF BACKGROUND DATA: No retrospective or prospective investigation has been conducted on the surgical treatment of contralateral recurrent lumbar disc herniation.

METHODS: Sixteen patients who underwent surgery for recurrent disc herniation at the same level as primary disc excision, but on the opposite side, were analyzed prospectively from the recurrence of contralateral radicular pain (Group 1). All patients had reported a satisfactory results after primary discectomy. Fifty consecutive patients who underwent disc excision during the study period, who did not report recurrent radicular pain, were analyzed for comparison (Group 2). Overall patient satisfaction, pain severity, functional outcome, and work status were evaluated.

RESULTS: At the 2-year follow-up, the clinical outcome was rated as satisfactory in 14 of 16 patients in Group 1 and in 45 of 50 in Group 2 (P > 0.05). Twelve patients in Group 1 and 42 in Group 2 had resumed their work or daily activities at the same level as before the operation (P > 0.05). Radicular pain was significantly improved in both groups at the 6-month and 2-year follow-ups. At the 6-month follow-up, low back pain was significantly improved only in the patients in Group 2; however, at the 2-year follow-up, low back pain was significantly improved in both groups.

CONCLUSIONS: Clinical results in patients reoperated on for contralateral recurrent lumbar disc herniation compare favorably with those reported after primary discectomy. The improvement of pain in the low back and lower limbs reported by the majority of patients 2 years after reoperation suggests that fusion is not needed in this patient population.

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