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Revision surgery for lumbar disc herniation

An analysis of 45 patients

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Summary

We reviewed 45 patients who had undergone repeated open operations for lumbar disc herniation. There were 26 men and 19 women with a mean follow up of 4.3 years. Twenty-four patients had had one previous discectomy, 12 had 2, and 9 had 3 or more; 11 needed a fusion without instrumentation. Residual or re-extruded disc hernias, either sub- or transligamentous, were frequently found at revision. Good to excellent results were obtained in 64%. Those who had a first-time revision had earlier improvement and better results. Complete removal and a thorough search for herniated disc material is essential when carrying out the initial operation for extruded or sequestrated herniation. At revision, removal of as much as possible of the remaining nucleus and annulus, but with minimal invasion of the posterior elements, is crucial for improving the outcome.

Résumé

Notre étude porte sur 45 patients ayant subi à plusieurs reprises une discectomie lombaire. Ce groupe était composé de 26 hommes et de 19 femmes suivis pendant 4,3 ans en moyenne (de 1 à 8 ans). Vingt-quatre patients avaient déjà été opérés une fois, 12 deux fois et 9 trois fois ou plus. Une arthrodèse était indiquée dans 11 cas. Les réinterventions ont montré que des hernies résiduelles ou ré-expulsées, sous-ligamentaires ou trans-ligamentaires, étaient souvent retrouvées. 64% (29/45) des patients ont eu de bons ou d'excellents résultats. Les patients n'ayant subi qu'une seule réintervention se sont rétablis plus rapidement et ont présenté de meilleurs résultats. Nous tenons à souligner qu'il est essentiel de procéder à l'ablation complète et à la recherche méticuleuse de tous les matériaux discaux herniés lors de la première intervention, en particulier pour les hernies expulsées ou séquestrées. En cas de réintervention il convient d'enlever autant d'anneau et de noyau résiduel que possible, quoique plus modérément en arrière, pour obtenir les meilleurs résultats.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Fukui Medical School, Shimoaizuki 23, Matsuoka, 910-11, Fukui, Japan

    H. Baba, Q. Chen, K. Kamitani & S. Imura

  2. Department of Orthopaedic Surgery, School of Medicine, Kanazawa University, Kanazawa, Japan

    K. Tomita

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  1. H. Baba
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  2. Q. Chen
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  3. K. Kamitani
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  4. S. Imura
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Baba, H., Chen, Q., Kamitani, K. et al. Revision surgery for lumbar disc herniation. International Orthopaedics 19, 98–102 (1995). https://doi.org/10.1007/BF00179969

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