Oral Presentation Sydney Spinal Symposium 2019

Recurrent Lumbar Disc Herniation (#2)

Saeed Kohan 1
  1. St George Hospital, Kogarah, NSW, Australia

Lumbar discectomy is an effective form of treatment for debilitating sciatica. Recurrent lumbar disc herniation (rLDH) remains a significant source of unsatisfactory outcome, with 5-15% incidence reported in literature. There are varying and sometimes conflicting factors influencing the risk of recurrent lumbar disc herniation as reported in the literature based on epidemiology, patient related factors, and surgical techniques.

Epidemiological factors including age, gender, smoking, diabetes and obesity have been noted to play a part. Other environmental factors such as cyclical loading across the disc is shown to be significant risk factors in rLDH. The disc related factors such as the disc height, degree and rate of degeneration, and extent of annular defect are also studied. Extent of disc removal is shown to be a significant risk factor. While aggressive discectomy is associated with lower rLDH, sequestrectomy alone is associated with higher recurrence rate but lower risk of long term disc degeneration and back pain.

Understanding these factors is vital in risk stratification for rLDH and long term outcomes.  Ultimately diagnostic tools to help prediction of pathological risk factors, and surgical methods to minimize the risk of recurrent disc herniation will be expected to lead to more satisfactory long term outcomes for the individual patient.