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Advancing insights into recurrent lumbar disc herniation: A comparative analysis of surgical approaches and a new classification.
Musa, Gerald; Abakirov, Medetbek Dzhumabekovich; Chmutin, Gennady E; Mamyrbaev, Samat Temirbekovich; Ramirez, Manuel De Jesus Encarnacion; Sichizya, Kachinga; Kim, Alexander V; Antonov, Gennady I; Chmutin, Egor G; Hovrin, Dmitri V; Slabov, Mihail V; Chaurasia, Bipin.
Afiliación
  • Musa G; Department of Neurological Diseases and Neurosurgery, Peoples' Friendship University of Russia (RUDN) Named After Patrice Lumumba, Moscow, Russia.
  • Abakirov MD; Department of Neurological Diseases and Neurosurgery, Peoples' Friendship University of Russia (RUDN) Named After Patrice Lumumba, Moscow, Russia.
  • Chmutin GE; Department of Neurological Diseases and Neurosurgery, Peoples' Friendship University of Russia (RUDN) Named After Patrice Lumumba, Moscow, Russia.
  • Mamyrbaev ST; Department of Neurosurgery, Kyrgyz State Medical Academy, Bishkek, Kyrgyzstan.
  • Ramirez MJE; Department of Neurological Diseases and Neurosurgery, Peoples' Friendship University of Russia (RUDN) Named After Patrice Lumumba, Moscow, Russia.
  • Sichizya K; Department of Neurosurgery, University Teaching Hospital, Lusaka, Zambia.
  • Kim AV; Department of Neurosurgery, City Clinical Hospital 68 Named After Demihov, Moscow, Russia.
  • Antonov GI; Department of Neurological Diseases and Neurosurgery, Peoples' Friendship University of Russia (RUDN) Named After Patrice Lumumba, Moscow, Russia.
  • Chmutin EG; Department of Neurological Diseases and Neurosurgery, Peoples' Friendship University of Russia (RUDN) Named After Patrice Lumumba, Moscow, Russia.
  • Hovrin DV; Department of Neurosurgery, City Clinical Hospital Named After C.C. Yudina, Moscow, Russia.
  • Slabov MV; Department of Neurosurgery, City Clinical Hospital Named After C.C. Yudina, Moscow, Russia.
  • Chaurasia B; Department of Neurosurgery, Neurosurgery Clinic, Birgunj, Nepal.
J Craniovertebr Junction Spine ; 15(1): 66-73, 2024.
Article en En | MEDLINE | ID: mdl-38644909
ABSTRACT

Background:

The management of recurrent lumbar disc herniation (rLDH) lacks a consensus. Consequently, the choice between repeat microdiscectomy (MD) without fusion, discectomy with fusion, or endoscopic discectomy without fusion typically hinges on the surgeon's expertise. This study conducts a comparative analysis of postoperative outcomes among these three techniques and proposes a straightforward classification system for rLDH aimed at optimizing management. Patients and

Methods:

We examined the patients treated for rLDH at our institution. Based on the presence of facet resection, Modic-2 changes, and segmental instability, they patients were categorized into three groups Types I, II, and III rLDH managed by repeat MD without fusion, MD with transforaminal lumbar interbody fusion (TLIF) (MD + TLIF), and transforaminal endoscopic discectomy (TFED), respectively.

Results:

A total of 127 patients were included 52 underwent MD + TLIF, 50 underwent MD alone, and 25 underwent TFED. Recurrence rates were 20%, 12%, and 0% for MD alone, TFED, and MD + TLIF, respectively. A facetectomy exceeding 75% correlated with an 84.6% recurrence risk, while segmental instability correlated with a 100% recurrence rate. Modic-2 changes were identified in 86.7% and 100% of patients experiencing recurrence following MD and TFED, respectively. TFED exhibited the lowest risk of durotomy (4%), the shortest operative time (70.80 ± 16.5), the least blood loss (33.60 ± 8.1), and the most favorable Visual Analog Scale score, and Oswestry Disability Index quality of life assessment at 2 years. No statistically significant differences were observed in these parameters between MD alone and MD + TLIF. Based on this analysis, a novel classification system for recurrent disc herniation was proposed.

Conclusion:

In young patients without segmental instability, prior facetectomy, and Modic-2 changes, TFED was available should take precedence over repeat MD alone. However, for patients with segmental instability, MD + TLIF is recommended. The suggested classification system has the potential to enhance patient selection and overall outcomes.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Idioma: En Revista: J Craniovertebr Junction Spine Año: 2024 Tipo del documento: Article País de afiliación: Rusia Pais de publicación: India
Texto completo
Añadir a Mi BVS
Imprimir
XML
PubMed Links
Buscar en Google

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Idioma: En Revista: J Craniovertebr Junction Spine Año: 2024 Tipo del documento: Article País de afiliación: Rusia Pais de publicación: India