Authors
Makarov S.А., Alexanyan M.М., Spirin O.А., Aganesov A.G.
Petrovsky Russian Research Center of Surgery, Moscow
Abstract
Rationale: Intervertebral disc herniation (IVDH) in the lumbar spine is the most common cause of pain in the lower extremities and associated disability. More than 10% of such patients require surgical intervention. Despite advances in surgical techniques, recurrence of IHD occurs at a rate of 0.5 to 25%. Recurrence of IHD leads to the development of pain syndrome, neurological deficit, disability, repeat surgery, and increased burden on the healthcare system.
Objective: to analyse the frequency and causes of recurrence of intervertebral disc herniation after microdiscectomy performed in our department, which will improve the results of surgical treatment and reduce the number of recurrences.
Methods: A retrospective study was conducted involving 644 patients who underwent microsurgical discectomy in the lumbar spine at the same level due to intervertebral disc herniation in the spinal surgery department of the Petrovsky Research Centre for Surgery between 2012 and 2020. Of these, 89 people (13.8%) developed a recurrence of intervertebral disc herniation (first group), while the rest of the patients did not develop a recurrence (second group).
Results: Men had a 1.474 times higher risk of recurrence than women. Patients with diabetes mellitus had a 1.654 times higher risk of recurrence than patients without diabetes. Smoking patients had a 2.023 times higher risk of recurrence. Patients with severe MDD degeneration (grade 4 and 5) had a recurrence risk 4.651 times higher than those with less severe MDD degeneration. In patients with protrusion, the risk of recurrence was 2.324 times higher than in patients with sequestered hernia; also, among patients with extrusion, the risk of recurrence was 2.516 times higher than with sequestered hernia. With paramedian hernia, the risk of recurrence is 5.271 times higher than with central hernia; in addition, in patients with foraminal hernia, the risk of recurrence is 6.460 times higher compared to central hernia.
Conclusion: Male gender, type 2 diabetes mellitus, smoking, IV–V degree intervertebral disc degeneration according to the Pfirrmann classification, protrusion and extrusion of the intervertebral disc, paramedian and foraminal location are noted as independent preoperative risk factors for the development of intervertebral disc herniation recurrence. In order to reduce the frequency of recurrence and revision surgery, it is important to minimise the influence of modifiable risk factors. Patients with risk factors that cannot be modified should be aware of the high risk of recurrence.
Keywords: herniated intervertebral disc, recurrence of herniated intervertebral disc, microdiscectomy, radicular syndrome.
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