Clinical Analysis of the Results of Reoperations for Recurrent Herniated lumbar Disc

ABSTRACT

Thirty-one Patients who underwent reoperation from Jan. 1983 to Dec. 1988. were analysed retrospectively. The results of reoperation showed the excellent recovery in 13 cases(42%) and good recovery in 12 cases(39%) in terms of pain relief and working capability. But 6 cases(19%) couldn't be managed successfully. The most common intraoperative findings were true recurrences(14 cases: 45%), missed disc material(7 cases: 23%), and small recurrent fragment embedded in epidural fibrosis(7 cases: 23%). The clinical result is affected predominantly by the intraoperative pathology and the time interval between the first and second operation. The excellent or good results could be achieved among patients with true recurrences occurred after more than 6 months following initial surgery and among the patients who were operated again within one month because of missed disc material, hematoma, and inadequate laminectomy and discectomy. But the patients who underwent reoperation between 1 month and 6 months because of a small recurrence and fibrosis or epidural fibrosis showed the poor results. The complete removal of disc, adequate bleeding control, adequate laminectomy were considered to be helpful to reduce the chance of reoperation. Microsurgery is advisable in reoperations because it can facilitate the dissection between fibrous scar and nerve root, making the small recurrent disc material removed completely.