Recurrence after surgery in lumbar disc protrusions

ABSTRACT

Persistent symptoms after operation for lumbar disc protrusions may be due to [1] disc prolapse at another level [2] residual disc material in the spinal canal [3] nerve root pressure by a hypertrophic facet joint or a narrow lateral recess ['root canal stenosis']. After careful investigation, any of these may call for re-operation but second procedures don't have a high success rate. This study is designed to verify the possible causes of recurrence after surgery for lumbar disc prolapse and their appropriate treatment regarding re-exploration. A follow-up and result of treatment in 100 cases operated upon for lumbar disc prolapse is presented. Clinical and radiological assessments including myelography and magnetic resonance imaging were done post-operatively in persistent symptoms including backache or sciatica. In this series, twelve patients required re-exploration, 9 patients had only one re-exploration and 3 patients had two explorations each. One patient had one re-exploration was subjected to sacro-iliac fusion. which improved his symptoms. In the majority of patients the causes of persistence of symptoms are beyond the control of the surgeon. Removal of disc prolapse is effective in most instances in relieving the pain in lower extremity but a large number of patients continue to suffer from further backache and a few from further leg pain of varying intensity. Re-exploration carries a bad prognosis but if a disc prolapse is found at re-exploration then the result is much more favorable