Mohamed AbdelBari Mattar¹, Ahmed A. Zaher¹, Mohamed Gomaa², Ashraf Ahmed Zaher²

Departments of Neurosurgery¹, Neurology²; Mansoura University; Egypt

Background: Many studies on recurrent disc herniation exist, however only mixed patient populations have been analyzed. Recurrent herniation following disc excision has been reported in 5–11% of patients. Objectives: To analyze the factors that influenced the outcomes of repeat discectomy through a retrospective evaluation of 31 patients with recurrent lumbar disc herniation. Methods: Recurrent lumbar disc herniation is considered when an ipsilateral or contralateral disc herniation at the same level happens, with a pain-free interval more than 6 months. MRI with contrast was done and revision surgery was performed in all patients using conventional open discectomy. Results: The mean pain-free interval was 31 months. During the revision surgery the disc pathology was of the contained type in 8 patients and the noncontained type in 23 patients. Epidural fibrosis was seen in 29 patients. All patients had follow-up of at least 1 year. At the final follow-up, their average JOA score was 24, with the average recovery rate of 72%. There were no demonstrated effects from age, sex, traumatic events, level of herniation, procedures of revision surgery, or dural tear on the recovery rate. However a negative impact on the recovery rate was found related to the following factors: times of prior surgery, side of recurrence, pain-free interval, duration of recurrence symptoms,   associated spinal stenosis. Conclusion: A revision surgery for recurrent lumbar disc herniation showed satisfactory results that were comparable with those of primary  discectomy, therefore a repeat  discectomy  can  be recommended  for  the  management  of  recurrent  lumbar  disc  herniation. [Egypt J Neurol Psychiat Neurosurg.  2012; 49(2): 143-148]

Key words: recurrent lumbar disc herniation, repeat discectomy, outcome.